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 |
|---|---|---|---|---|
| Nerve conduction studies 11-12 CPT 95912 | $1,032.20 | $1,876.72 | $276.82 – $712.35 | 4 |
| Nerve conduction studies 1-2 CPT 95907 | not published | not published | $160.18 – $412.19 | 4 |
| Nerve conduction studies 13+ CPT 95913 | $1,327.39 | $2,413.43 | $276.82 – $712.35 | 4 |
| Nerve conduction studies 3-4 CPT 95908 | $430.32 | $782.40 | $160.18 – $412.19 | 4 |
| Nerve conduction studies 5-6 CPT 95909 | $515.13 | $936.60 | $160.18 – $412.19 | 4 |
| Nerve conduction studies 9-10 CPT 95911 | $890.94 | $1,619.89 | $276.82 – $712.35 | 4 |
| Nerve graft add-on CPT 64901 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Nerve graft add-on CPT 64902 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Nerve graft head/neck <4 cm CPT 64885 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Nerve graft head/neck >4 cm CPT 64886 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Nerve palsy fascial graft CPT 15840 | not published | not published | $2,628.85 – $8,770.00 | 6 |
| Nerve palsy microsurg graft CPT 15842 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Nerve palsy muscle graft CPT 15841 | not published | not published | $2,628.85 – $8,770.00 | 6 |
| Nerve pedicle transfer CPT 64905 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Nerve pedicle transfer CPT 64907 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Nerve repair w/allograft CPT 64910 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Nerve surgery CPT 64859 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Nerve teasing preparations CPT 88362 | not published | not published | $210.53 – $1,538.03 | 5 |
| Nesiritide injection HCPCS J2325 | not published | not published | $79.25 – $79.25 | 1 |
| Neurectomy foot CPT 28055 | not published | not published | $1,448.59 – $7,791.00 | 6 |
| Neurectomy hamstring CPT 27325 | not published | not published | $1,448.59 – $4,761.00 | 6 |
| Neurectomy popliteal CPT 27326 | not published | not published | $1,448.59 – $4,761.00 | 6 |
| Neuroeltrd stim post tibial CPT 64566 | not published | not published | $227.71 – $2,334.00 | 6 |
| Neuroendoscopy add-on CPT 62160 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Neurolysis celiac plexus CPT 64680 | $1,566.40 | $2,848.00 | $656.13 – $3,030.00 | 6 |
| Neurolysis trigeminal nerve CPT 64600 | not published | not published | $656.13 – $3,030.00 | 6 |
| Neuromuscular junction testing ea nerve any 1 method CPT 95937 | $275.22 | $500.40 | $95.45 – $245.63 | 4 |
| Neuroplasty digital 1/both same digit CPT 64702 | not published | not published | $1,448.59 – $7,791.00 | 6 |
| Neuroplasty nerve of hand or foot 64704 CPT 64704 | not published | not published | $1,448.59 – $7,791.00 | 6 |
| Neurorraphy w/vein autograft CPT 64911 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Neurovascular pedicle flap CPT 15750 | not published | not published | $2,628.85 – $8,770.00 | 6 |
| Neutrlzg antb sarscov2 scr CPT 86408 | not published | not published | $31.60 – $81.31 | 7 |
| Neutrlzg antb sarscov2 titer CPT 86409 | not published | not published | $59.71 – $153.65 | 7 |
| Neutron beam tx complex CPT 77423 | not published | not published | $324.23 – $1,054.79 | 4 |
| New Patient Office Visit (level 2) CPT 99202 | $210.65 | $383.00 | not published | 0 |
| New Patient Office Visit (level 3) CPT 99203 | $222.20 | $404.00 | not published | 0 |
| New Patient Office Visit (level 4) CPT 99204 | $260.15 | $473.00 | not published | 0 |
| New Patient Office Visit (level 5) CPT 99205 | $295.90 | $538.00 | not published | 0 |
| Nfct agt gntyp alys sarscov2 CPT 87913 | not published | not published | $193.09 – $496.88 | 7 |
| Nfct ds bv&vaginitis dna alg CPT 81514 | not published | not published | $197.24 – $507.57 | 7 |
| Nfros nfrot w/drg CPT 50040 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| N. gonorrhoeae assay w/optic CPT 87850 | not published | not published | $18.42 – $47.40 | 7 |
| N.gonorrhoeae dna quant CPT 87592 | not published | not published | $32.13 – $82.68 | 7 |
| Nicardipine 25 mg/10 ml intravenous solution HCPCS J2404 | not published | not published | $0.08 – $0.21 | 5 |
| Nikaidoh proc CPT 33782 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Nikaidoh proc w/ostia implt CPT 33783 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| N-invas est c ffr sw aly cta CPT 75580 | $1,882.10 | $3,422.00 | $637.04 – $1,639.32 | 4 |
| Nipple/areola reconst 19350 CPT 19350 | not published | not published | $2,904.59 – $7,791.00 | 6 |
| Nipple exploration CPT 19110 | not published | not published | $2,904.59 – $7,791.00 | 6 |
| Nitroblue tetrazolium dye CPT 86384 | not published | not published | $10.21 – $26.27 | 7 |
| Nitrogen n-13 ammonia HCPCS A9526 | not published | not published | $2,002.56 – $2,002.56 | 1 |
| Nitroglycerin 50 mg/250 ml (200 mcg/ml) in 5 % dextrose intravenous HCPCS J2305 | not published | not published | $1.47 – $3.84 | 5 |
| Nivolumab 10 mg/ml intravenous solution (wrapper) HCPCS J9299 | not published | not published | $25.67 – $87.95 | 8 |
| Nivolumab 240 mg-relatlimab-rmbw 80 mg/20 ml intravenous solution HCPCS J9298 | not published | not published | $154.13 – $527.79 | 8 |
| Njx aa&/strd lmbr plex nfs CPT 64449 | not published | not published | $656.13 – $3,030.00 | 6 |
| Njx aa&/strd nrv nrvtg si jt CPT 64451 | $1,918.40 | $3,488.00 | $523.65 – $3,030.00 | 6 |
| Njx aa&/strd sc nrv nfs img CPT 64446 | $1,610.95 | $2,929.00 | $656.13 – $3,030.00 | 6 |
| Njx aa&/strd vagus nrv CPT 64408 | not published | not published | $227.71 – $2,334.00 | 6 |
| Njx cath slct p angrph mapca CPT 93575 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Njx cath slct p-art angrp bi CPT 93573 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Njx cath slct pulm vn angrph CPT 93574 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Njx chemonucleolysis lmbr CPT 62292 | not published | not published | $1,448.59 – $7,791.00 | 6 |
| Njx cth slct p-art angrp uni CPT 93569 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Njx interlaminar crv/thrc CPT 62324 | $1,128.05 | $2,051.00 | $656.13 – $3,030.00 | 6 |
| Njx interlaminar crv/thrc CPT 62325 | $1,630.20 | $2,964.00 | $656.13 – $3,030.00 | 6 |
| Njx interlaminar lmbr/sac CPT 62326 | $1,128.05 | $2,051.00 | $656.13 – $3,030.00 | 6 |
| Njx interlaminar lmbr/sac CPT 62327 | $1,691.80 | $3,076.00 | $656.13 – $3,030.00 | 6 |
| Njx px nfrosgrm &/urtrgrm CPT 50430 | $1,001.00 | $1,820.00 | $517.28 – $3,030.00 | 6 |
| Njx px peyronie ds exps plaq CPT 54205 | not published | not published | $3,977.55 – $10,235.57 | 6 |
| Nl comp cgen kdn abnormality CPT 50070 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Nl removal calculus CPT 50060 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Nl rmvl lg staghorn calculus CPT 50075 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Nl sec surg operj calculus CPT 50065 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Nm imaging bone/joint 3 phase study CPT 78315 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Nm imaging bone/joint whole body CPT 78306 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Nm imaging cardiac blood pooling planar single study at rest or stress CPT 78472 | $2,038.30 | $3,706.00 | $296.56 – $763.16 | 4 |
| Nm imaging gastric emptying study CPT 78264 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Nm imaging gastrointestinal acute blood loss CPT 78278 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Nm imaging hepatobiliary system w/pharmacologic intervention CPT 78227 | $1,936.00 | $3,520.00 | $402.79 – $1,036.52 | 4 |
| Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention CPT 78708 | $1,936.00 | $3,520.00 | $397.30 – $1,036.52 | 4 |
| Nm imaging pulmonary ventilation/perfusion CPT 78582 | $1,936.00 | $3,520.00 | $402.79 – $1,036.52 | 4 |
| Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s) CPT 78014 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Nm radiopharmaceutical therapy oral administration CPT 79005 | $1,936.00 | $3,520.00 | $164.18 – $445.43 | 4 |
| No knee/ankle joints with ft b HCPCS L5210 | not published | not published | $2,665.46 – $6,859.12 | 4 |
| No knee joint with artic ali HCPCS L5220 | not published | not published | $2,936.18 – $7,555.78 | 4 |
| Non-blind interatrial shunt HCPCS C9760 | not published | not published | $7,609.00 – $54,996.00 | 6 |
| Non-card vasc flow imaging CPT 78445 | not published | not published | $296.56 – $763.16 | 4 |
| Non-corrosive finish HCPCS L2780 | not published | not published | $58.33 – $150.10 | 4 |
| Non-cov proc, clinical trial HCPCS G0294 | not published | not published | $27.71 – $71.30 | 4 |
| Non-cov surg proc,clin trial HCPCS G0293 | not published | not published | $27.71 – $71.30 | 4 |
| Non-imaging heart function CPT 78414 | not published | not published | $171.27 – $1,036.52 | 4 |
| Noninv pace analysis CPT 93724 | $706.75 | $1,285.00 | not published | 0 |
| Non-molded lacer HCPCS L2320 | not published | not published | $177.81 – $457.56 | 4 |
| Non-ophthalmic fva HCPCS C9733 | not published | not published | $258.81 – $665.99 | 4 |
| Noonan spectrum disorders CPT 81442 | not published | not published | $894.41 – $4,137.15 | 7 |
| No pt prsnt train initial 30 HCPCS G0541 | not published | not published | $21.46 – $55.21 | 4 |
| Novachor 1 sq cm HCPCS Q4194 | not published | not published | $92.32 – $2,338.41 | 7 |
| Npm1 gene CPT 81310 | not published | not published | $184.89 – $475.78 | 7 |
| Nps surg dilat eust tube bi CPT 69706 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Nps surg dilat eust tube uni CPT 69705 | not published | not published | $4,391.52 – $16,106.00 | 6 |
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.