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 |
|---|---|---|---|---|
| Npsy tst eval phsy/qhp 1st hr CPT 96132 | $204.05 | $371.00 | $276.82 – $712.35 | 4 |
| Npsy tst eval phsy/qhp ea l hr CPT 96133 | $199.10 | $362.00 | not published | 0 |
| Nqhp ol dig assmt&mgmt 11-20 CPT 98971 | $76.45 | $139.00 | $13.82 – $35.55 | 4 |
| Nqhp ol dig assmt&mgmt 21+ CPT 98972 | $120.45 | $219.00 | $21.11 – $54.33 | 4 |
| Nqhp ol dig assmt&mgmt 5-10 CPT 98970 | $43.45 | $79.00 | $7.54 – $19.40 | 4 |
| Nras gene variants exon 2&3 CPT 81311 | $786.50 | $1,430.00 | $221.84 – $570.87 | 7 |
| Nr lnr acclrtr tx max 5 sessions CPT 77373 | $5,894.35 | $10,717.00 | $1,326.43 – $3,413.36 | 4 |
| Nrv grf 1strnd arm/leg >4 cm CPT 64893 | not published | not published | $2,534.21 – $16,106.00 | 6 |
| Nrv grf 1strnd arm/leg <4cm CPT 64892 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Nrv grf 1strnd hnd/foot <4cm CPT 64890 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Nrv grf 1strnd hnd/foot >4cm CPT 64891 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Nrv grf mltst arm/leg <4 cm CPT 64897 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Nrv grf mltst arm/leg >4 cm CPT 64898 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Nrv grf mltst hnd/foot <4 cm CPT 64895 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Nrv grf mltst hnd/foot >4 cm CPT 64896 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Nrv rpr w/nrv algrft 1st CPT 64912 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Nrv rpr w/nrv algrft ea addl CPT 64913 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Nsl/sins ndsc med&inf dcmprn CPT 31293 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Nsl/sins ndsc med/inf dcmprn CPT 31292 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Nsl/sins ndsc sphn tiss rmvl CPT 31259 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Nsl/sins ndsc surg frnt sins CPT 31296 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Nsl/sins ndsc surg frnt&sphn CPT 31298 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Nsl/sins ndsc surg max sins CPT 31295 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Nsl/sins ndsc surg on dcmprn CPT 31294 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Nsl/sins ndsc surg sphn sins CPT 31297 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Nsl/sins ndsc total CPT 31253 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Nsl/sins ndsc tot w/sphendt CPT 31257 | not published | not published | $5,235.45 – $13,472.56 | 6 |
| Nsl/sinus endoscopy surg dcr CPT 31239 | not published | not published | $2,765.81 – $7,791.00 | 6 |
| Nsl/sinus ndsc cryoabltj pnn CPT 31243 | not published | not published | $4,391.52 – $15,691.00 | 5 |
| Nsl/sinus ndsc rf abltj pnn CPT 31242 | not published | not published | $4,391.52 – $15,691.00 | 5 |
| Nsl/sns ndsc lig sphnptn art CPT 31241 | not published | not published | $1,320.39 – $7,791.00 | 6 |
| Ntraop hipec px ea add 30min CPT 96548 | not published | not published | $2,334.00 – $2,334.00 | 1 |
| Ntrk1 translocation analysis CPT 81191 | not published | not published | $155.48 – $400.11 | 7 |
| Ntrk2 translocation analysis CPT 81192 | not published | not published | $155.48 – $400.11 | 7 |
| Ntrk3 translocation analysis CPT 81193 | not published | not published | $155.48 – $400.11 | 7 |
| Ntrk translocation analysis CPT 81194 | not published | not published | $388.71 – $1,000.28 | 7 |
| Ntsty modul rad tx dlvr cplx CPT 77386 | $2,450.80 | $4,456.00 | $1,150.59 – $1,150.59 | 1 |
| Ntsty modul rad tx dlvr smpl CPT 77385 | $2,450.80 | $4,456.00 | $1,148.50 – $1,148.50 | 1 |
| Nuclear exam of tear flow CPT 78660 | not published | not published | $296.56 – $763.16 | 4 |
| Nuclear matrix protein 22 CPT 86386 | not published | not published | $16.34 – $42.04 | 7 |
| Nuclear rx intra-arterial CPT 79445 | $545.60 | $992.00 | $173.10 – $445.43 | 4 |
| Nuclear rx intra-articular CPT 79440 | not published | not published | $168.24 – $445.43 | 4 |
| Nuclear rx intracav admin CPT 79200 | not published | not published | $173.10 – $445.43 | 4 |
| Nuclear rx IV admin CPT 79101 | $1,936.00 | $3,520.00 | $159.92 – $445.43 | 4 |
| Nuclear Stress Test (Heart) CPT 78452 | $2,445.30 | $4,446.00 | $960.41 – $2,471.46 | 4 |
| Nuclr rx interstit colloid CPT 79300 | not published | not published | $173.10 – $445.43 | 4 |
| Nudge control elbow lock HCPCS L6637 | not published | not published | $373.35 – $960.75 | 4 |
| Nudt15 gene common variants CPT 81306 | $775.50 | $1,410.00 | $218.52 – $562.32 | 7 |
| Nushield 1 square cm HCPCS Q4160 | not published | not published | $92.32 – $1,007.00 | 7 |
| Nusinersen (pf) 12 mg/5 ml intrathecal solution HCPCS J2326 | not published | not published | $1,000.09 – $3,394.92 | 5 |
| Obinutuzumab 1,000 mg/40 ml intravenous solution HCPCS J9301 | not published | not published | $63.35 – $203.73 | 8 |
| Obltrj a-pulm sep def w/byp CPT 33814 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Observation direct referral from physician office for admission HCPCS G0379 | $74.80 | $136.00 | $441.78 – $1,136.86 | 4 |
| Observation per hour HCPCS G0378 | $0.73 | $1.33 | not published | 0 |
| Obstetrical care 59410 CPT 59410 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Obstetric panel inc HIV tstg CPT 80081 | not published | not published | $56.14 – $144.48 | 7 |
| Obstetrics panel CPT 80055 | not published | not published | $35.86 – $92.27 | 7 |
| Obtaining screen pap smear HCPCS Q0091 | $20.24 | $36.80 | $21.46 – $55.21 | 5 |
| Ob Ultrasound nuchal meas 1 gest CPT 76813 | $291.50 | $530.00 | $77.56 – $199.58 | 4 |
| Ob Ultrasound nuchal meas add-on CPT 76814 | not published | not published | $100.52 – $100.52 | 1 |
| Occlude fallopian tube(s) device 58615 CPT 58615 | not published | not published | $2,401.40 – $7,791.00 | 6 |
| Ocrelizumab 30 mg/ml intravenous solution HCPCS J2350 | not published | not published | $45.73 – $160.00 | 8 |
| Octreotide acetate 100 mcg/ml injection (wrapper) HCPCS J2354 | not published | not published | $0.65 – $2.21 | 5 |
| Octreotide,microspheres ER 20 mg intramuscular susp, extended release HCPCS J2353 | not published | not published | $156.07 – $594.51 | 8 |
| Ocular photodynamic ther CPT 67221 | not published | not published | $408.01 – $3,030.00 | 6 |
| Ocular reconst transplant CPT 65780 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Ocular reconst transplant CPT 65781 | not published | not published | $3,947.51 – $16,106.00 | 6 |
| Ocular reconst transplant CPT 65782 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Ofatumumab 20 mg/ml intravenous solution (wrapper) HCPCS J9302 | not published | not published | $46.68 – $169.42 | 5 |
| Off base opioid tx, 60 m HCPCS G2087 | not published | not published | $131.67 – $338.84 | 4 |
| Off base opioid tx 70min HCPCS G2086 | not published | not published | $131.67 – $338.84 | 4 |
| Offset knee joint each HCPCS L2390 | not published | not published | $94.34 – $242.77 | 4 |
| Offset knee joint heavy duty HCPCS L2395 | not published | not published | $134.85 – $347.01 | 4 |
| Olanzapine 10 mg intramuscular solution HCPCS J2359 | not published | not published | $0.81 – $2.05 | 5 |
| Olanzapine long-acting inj HCPCS J2358 | not published | not published | $3.15 – $7.95 | 5 |
| Omalizumab 150 mg/ml subcutaneous syringe (wrapper) HCPCS J2357 | not published | not published | $34.94 – $102.80 | 8 |
| Omental flap extra-abdom 49904 CPT 49904 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Omental flap intra-abdom 49905 CPT 49905 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Onc breast mrna 12 genes CPT 81522 | not published | not published | $2,904.75 – $7,474.89 | 7 |
| Onc breast mrna 58 genes CPT 81520 | not published | not published | $1,882.66 – $4,844.71 | 7 |
| Onc breast mrna 70 genes CPT 81521 | not published | not published | $2,904.75 – $7,474.89 | 7 |
| Onc brst mrna 11 genes CPT 81518 | not published | not published | $2,904.75 – $7,474.89 | 7 |
| Onc brst mrna 70 cnt 31 gene CPT 81523 | not published | not published | $2,904.75 – $7,474.89 | 7 |
| Onc cutan mlnma mrna 31 gene CPT 81529 | not published | not published | $5,394.75 – $13,882.49 | 7 |
| Oncology colon mrna CPT 81525 | not published | not published | $2,337.00 – $6,013.88 | 7 |
| Oncology colorectal scr CPT 81528 | not published | not published | $381.65 – $982.12 | 7 |
| Oncology gynecologic CPT 81535 | not published | not published | $434.60 – $1,118.36 | 7 |
| Oncology gynecologic CPT 81536 | not published | not published | $133.17 – $342.69 | 7 |
| Oncology lung CPT 81538 | not published | not published | $2,153.25 – $5,541.03 | 7 |
| Oncology prostate prob score CPT 81539 | not published | not published | $570.00 – $1,466.80 | 7 |
| Oncology tissue of origin CPT 81504 | not published | not published | $390.00 – $1,003.60 | 7 |
| Oncology tum unknown origin CPT 81540 | not published | not published | $2,812.50 – $7,237.50 | 7 |
| Onco (ovar) five proteins CPT 81503 | not published | not published | $672.75 – $1,731.21 | 7 |
| Onco (ovar) two proteins CPT 81500 | not published | not published | $195.38 – $502.76 | 7 |
| Oncoprotein dcp CPT 83951 | $102.30 | $186.00 | $48.31 – $124.31 | 7 |
| Oncoprotein her-2/neu CPT 83950 | not published | not published | $48.31 – $124.31 | 7 |
| Onc prostate 3 genes CPT 81551 | not published | not published | $1,522.50 – $3,917.90 | 7 |
| Onc prostate mrna 22 cnt gen CPT 81542 | not published | not published | $2,904.75 – $7,474.89 | 7 |
| Onc prostate mrna 46 genes CPT 81541 | not published | not published | $2,904.75 – $7,474.89 | 7 |
| Onc thyr mrna 10,196 gen alg CPT 81546 | not published | not published | $2,700.00 – $6,948.00 | 7 |
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.