SSM Health St. Agnes Hospital - Fond du Lac
430 E Division St, Fond Du Lac, WI · SSM Health · · NPI 1346228541
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Muscle-skin graft arm CPT 15736 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Muscle-skin graft leg CPT 15738 | not published | not published | $2,628.85 – $8,770.00 | 6 |
| Muscle-skin graft trunk CPT 15734 | not published | not published | $2,628.85 – $8,770.00 | 6 |
| Muscle test cran nerv unilat CPT 95867 | $180.95 | $329.00 | $160.18 – $412.19 | 4 |
| Muscle test hemidiaphragm CPT 95866 | not published | not published | $95.45 – $245.63 | 4 |
| Muscle test larynx CPT 95865 | $188.65 | $343.00 | $98.70 – $253.99 | 4 |
| Muscle test one fiber CPT 95872 | not published | not published | $160.18 – $412.19 | 4 |
| Muscle transfers CPT 23397 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Muscle transfer shoulder/arm CPT 23395 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Musc myoq/fscq flp h&n pedcl CPT 15733 | not published | not published | $2,628.85 – $8,770.00 | 6 |
| Musc/tdn transfer upr a/e 1 CPT 24301 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Mycobacteria dna amp probe CPT 87551 | $107.80 | $196.00 | $36.18 – $93.10 | 7 |
| Mycobacteria dna dir probe CPT 87550 | not published | not published | $15.04 – $38.70 | 7 |
| Mycobacteria dna quant CPT 87552 | not published | not published | $32.13 – $82.68 | 7 |
| Mycophenolate mofetil 250 mg capsule HCPCS J7517 | not published | not published | $0.16 – $0.41 | 5 |
| Mycophenolic acid HCPCS J7518 | not published | not published | $0.42 – $1.30 | 5 |
| Mycoplasma antibody igm CPT 86738 | $79.20 | $144.00 | $9.93 – $25.55 | 7 |
| Myd88 gene p.leu265pro vrnt CPT 81305 | $770.00 | $1,400.00 | $131.55 – $338.52 | 7 |
| Myelogphy 2/> spine regions CPT 72270 | not published | not published | $197.94 – $1,496.49 | 4 |
| Myelography l-s spine CPT 72265 | not published | not published | $165.86 – $1,496.49 | 4 |
| Myelography neck spine CPT 72240 | not published | not published | $171.80 – $1,496.49 | 4 |
| Myelography thoracic spine CPT 72255 | not published | not published | $168.24 – $1,496.49 | 4 |
| Myelography via inj w/s&i 2+ regions CPT 62305 | $3,054.15 | $5,553.00 | $581.54 – $3,030.00 | 6 |
| Myelography via inj w/s&i cervical CPT 62302 | $2,109.80 | $3,836.00 | $581.54 – $3,030.00 | 6 |
| Myelography via inj w/s&i lumbosacral CPT 62304 | $2,352.35 | $4,277.00 | $581.54 – $3,030.00 | 6 |
| Myelography via inj w/s&i thoracic CPT 62303 | $2,272.05 | $4,131.00 | $581.54 – $3,030.00 | 6 |
| Myeloperoxidase ab multi step qualitative/semiquantitative CPT 83516 | $161.70 | $294.00 | $8.65 – $22.25 | 7 |
| Myocardial resection 33542 CPT 33542 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Myocrd img pet 1std rst/strs CPT 78491 | $3,722.95 | $6,769.00 | $1,060.78 – $2,729.74 | 4 |
| Myocrd img pet 1 std w/ct CPT 78429 | not published | not published | $1,060.78 – $2,729.74 | 4 |
| Myocrd img pet 2rtracer CPT 78432 | not published | not published | $1,125.83 – $2,897.13 | 4 |
| Myocrd img pet 2rtracer CT CPT 78433 | not published | not published | $1,634.10 – $4,205.08 | 4 |
| Myocrd img pet mlt rst&strs CPT 78492 | not published | not published | $1,060.78 – $2,729.74 | 4 |
| Myocrd img pet rst&strs CT CPT 78431 | not published | not published | $1,634.10 – $4,205.08 | 4 |
| Myocrd img pet rst/strs w/ct CPT 78430 | not published | not published | $1,060.78 – $2,729.74 | 4 |
| Myomectomy abdom complex CPT 58146 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Myomectomy abdom method CPT 58140 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Myomectomy vag method CPT 58145 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Myringoplasty CPT 69620 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Nabilone oral HCPCS J8650 | not published | not published | $41.38 – $41.38 | 1 |
| Nafcillin 2 gram solution for injection HCPCS J2290 | not published | not published | $0.11 – $0.76 | 2 |
| Nalbuphine 10 mg/ml injection solution HCPCS J2300 | not published | not published | $3.39 – $9.34 | 5 |
| Naloxone 0.4 mg/ml injection (wrapper) HCPCS J2312 | not published | not published | $0.13 – $0.13 | 1 |
| Naltrexone, depot form HCPCS J2315 | not published | not published | $3.39 – $11.22 | 8 |
| Nandrolone decanoate 50 mg HCPCS J2320 | not published | not published | $10.56 – $10.56 | 1 |
| Narcosynthesis CPT 90865 | not published | not published | $131.67 – $338.84 | 4 |
| Nasal endoscopy dx uni/bi separate proc CPT 31231 | not published | not published | $148.07 – $2,334.00 | 6 |
| Nasal endoscopy with removal of nasal foreign body CPT 30999 | not published | not published | $175.70 – $2,334.00 | 6 |
| Nasal function studies CPT 92512 | not published | not published | $160.18 – $412.19 | 4 |
| Nasal septal prosthesis HCPCS L8047 | not published | not published | $1,271.19 – $3,271.20 | 4 |
| Nasal/sinus endoscopy surg CPT 31287 | not published | not published | $4,956.00 – $13,472.56 | 7 |
| Nasal/sinus endoscopy surg CPT 31290 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Nasal/sinus endoscopy surg CPT 31291 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Nasal/sinus endoscopy surg w/bx 31237 CPT 31237 | not published | not published | $1,320.39 – $4,761.00 | 6 |
| Nasal/sinus endo spendt remove tiss 31288 CPT 31288 | not published | not published | $4,956.00 – $13,472.56 | 7 |
| Nasal/sinus endo surg w/concha bullosa resct 31240 CPT 31240 | not published | not published | $1,320.39 – $7,791.00 | 6 |
| Nasal/sinus endo w/ethmoidectomy part 31254 CPT 31254 | not published | not published | $4,956.00 – $13,472.56 | 7 |
| Nasal/sinus endo w/ethmoidectomy tot 31255 CPT 31255 | not published | not published | $4,956.00 – $13,472.56 | 7 |
| Nasal/sinus endo w/front sinus expl 31276 CPT 31276 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Nasal/sinus maxillary endoscopy dx 31233 CPT 31233 | not published | not published | $290.14 – $2,334.00 | 6 |
| Nasal/sinus sphenoid endoscopy dx 31235 CPT 31235 | not published | not published | $1,320.39 – $4,761.00 | 6 |
| Nasal sinus therapy CPT 30210 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Nasopharyngoscopy w/endoscope CPT 92511 | $229.90 | $418.00 | $148.07 – $381.05 | 4 |
| Natalizumab 300 mg/15 ml intravenous solution HCPCS J2323 | not published | not published | $18.30 – $65.01 | 8 |
| Natriuretic peptide CPT 83880 | $195.25 | $355.00 | $29.44 – $75.77 | 7 |
| Natural killer cells total count CPT 86357 | $312.95 | $569.00 | $28.30 – $72.82 | 7 |
| Navigational bronchoscopy 31627 CPT 31627 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Nav srv peer sup 60 min pr m HCPCS G0140 | not published | not published | $75.36 – $193.93 | 4 |
| N block inj common digit CPT 64632 | not published | not published | $227.71 – $2,334.00 | 6 |
| N block inj hypogas plxs CPT 64517 | $1,065.90 | $1,938.00 | $656.13 – $3,030.00 | 6 |
| Nctrnl pen tmscn&/rgdity tst CPT 54250 | not published | not published | $185.35 – $2,334.00 | 6 |
| Ndl emg musc 1 xtr/non-limb CPT 95870 | $138.05 | $251.00 | $98.70 – $253.99 | 4 |
| Ndl insj without njx 1 or 2 musc CPT 20560 | not published | not published | $21.46 – $2,334.00 | 6 |
| Ndl insj without njx 3+ musc CPT 20561 | not published | not published | $21.46 – $2,334.00 | 6 |
| Ndl oculoelectromyography 1+ CPT 92265 | not published | not published | $43.76 – $112.62 | 4 |
| Ndsc dcmprn 1 ntrspc lumbar CPT 62380 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Ndsc hrv uxtr art 1 sgm cab CPT 33509 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Neck (Cervical Spine) CT scan (with and without contrast) CPT 72127 | $1,515.80 | $2,756.00 | $130.12 – $334.84 | 4 |
| Neck (Cervical Spine) CT scan (with contrast) CPT 72126 | $1,443.75 | $2,625.00 | $258.81 – $665.99 | 4 |
| Neck (Cervical Spine) CT scan (without contrast) CPT 72125 | $1,375.00 | $2,500.00 | $77.56 – $199.58 | 4 |
| Neck (Cervical Spine) MRI (with and without contrast) CPT 72156 | $1,967.35 | $3,577.00 | $258.81 – $665.99 | 4 |
| Neck (Cervical Spine) MRI (with contrast) CPT 72142 | $1,873.85 | $3,407.00 | $258.81 – $665.99 | 4 |
| Neck (Cervical Spine) MRI (without contrast) CPT 72141 | $1,784.20 | $3,244.00 | $177.00 – $455.49 | 4 |
| Neck MRA (blood vessel MRI, with and without contrast) CPT 70549 | $1,823.25 | $3,315.00 | $258.81 – $665.99 | 4 |
| Neck MRA (blood vessel MRI, with contrast) CPT 70548 | $1,736.35 | $3,157.00 | $258.81 – $665.99 | 4 |
| Neck MRA (blood vessel MRI, without contrast) CPT 70547 | $1,653.85 | $3,007.00 | $177.00 – $455.49 | 4 |
| Neck spine disk surgery CPT 63020 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Neck spine disk surgery 63075 CPT 63075 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Neck spine disk surgery 63076 CPT 63076 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Neisseria meningitidis CPT 86741 | not published | not published | $9.89 – $25.46 | 7 |
| Nelarabine injection HCPCS J9261 | not published | not published | $49.06 – $203.53 | 8 |
| Neopatch or therion, 1 sq cm HCPCS Q4176 | not published | not published | $92.32 – $483.52 | 5 |
| Neostigmine methylsulfate 1 mg/ml injection (wrapper) HCPCS J2710 | not published | not published | $4.52 – $4.52 | 1 |
| Neox 100 or clarix 100 HCPCS Q4156 | not published | not published | $71.23 – $237.56 | 7 |
| Nephrectomy open 50220 CPT 50220 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Nephrectomy partial CPT 50240 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Nephrotomy w/exploration CPT 50045 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Nerobehav stas exam by psy/md f2f 1st hr CPT 96116 | $89.10 | $162.00 | $160.18 – $412.19 | 4 |
| Nerobehav stas exam phys/qhp f2f ea l hr CPT 96121 | $89.10 | $162.00 | not published | 0 |
| Nerve conduction 7-8 studies CPT 95910 | $761.48 | $1,384.50 | $276.82 – $712.35 | 4 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.