SSM Health St. Agnes Hospital-fond Du Lac
Fond Du Lac, WI
Posts prices for 40 of the 66 common shoppable procedures we track. Price file retrieved 2026-09-08.
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| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Upper GI endoscopy (EGD), diagnostic (43235) | $361.35 | $657 | 0.4× |
| Epidural injection, lumbar/sacral (with imaging) (62322) | $1,072.50 | $1,950 | 1.2× |
| Transforaminal epidural injection, lumbar/sacral (64483) range across 2 matching MRF lines |
$2,226.95–$4,455 | $4,049–$8,100 | varies |
| CT head/brain without contrast (70450) | $1,375 | $2,500 | 13.3× |
| MRI brain without contrast (70551) | $1,672 | $3,040 | 7.1× |
| MRI brain with contrast (70552) | $1,755.60 | $3,192 | 5.1× |
| MRI brain without and with contrast (70553) | $1,843.60 | $3,352 | 5.3× |
| X-ray lower spine, 4+ views (72110) | $304.15 | $553 | 2.9× |
| MRI lumbar spine without contrast (72148) | $2,257.20 | $4,104 | 9.6× |
| CT pelvis with contrast (72193) | $1,558.15 | $2,833 | 9.0× |
| MRI lower-extremity joint without contrast (73721) | $2,296.80 | $4,176 | 9.7× |
| CT abdomen and pelvis with contrast (74177) | $1,713.25 | $3,115 | 5.0× |
| Ultrasound, abdomen complete (76700) | $674.30 | $1,226 | 6.5× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) range across 2 matching MRF lines |
$400.95–$460.90 | $729–$838 | varies |
| Ultrasound, transvaginal (76830) | $409.20 | $744 | 4.0× |
| Mammography, one breast (diagnostic) (77065) | $199.65 | $363 | 2.3× |
| Mammography, both breasts (diagnostic) (77066) | $399.30 | $726 | 3.6× |
| Mammography, screening (bilateral) (77067) range across 2 matching MRF lines |
$108.90–$217.25 | $198–$395 | varies |
| Basic metabolic panel (80048) range across 2 matching MRF lines |
$97.35–$100.10 | $177–$182 | varies |
| Comprehensive metabolic panel (80053) | $132.55 | $241 | 12.6× |
| Lipid panel (80061) | $118.80 | $216 | 8.9× |
| Renal function panel (80069) | $57.75 | $105 | 6.7× |
| Hepatic function panel (80076) | $93.50 | $170 | 11.4× |
| PSA, total (84153) range across 3 matching MRF lines |
$119.90–$146.85 | $218–$267 | varies |
| Thyroid stimulating hormone (TSH) (84443) | $138.60 | $252 | 8.3× |
| CBC with automated differential (85025) | $75.35 | $137 | 9.7× |
| CBC, automated (85027) | $59.40 | $108 | 9.2× |
| Prothrombin time (PT) (85610) range across 8 matching MRF lines |
$22.55–$31.35 | $41–$57 | varies |
| Partial thromboplastin time (PTT) (85730) | $19.80 | $36 | 3.3× |
| Psychotherapy, 30 minutes (90832) range across 3 matching MRF lines |
$92.40–$102.30 | $168–$186 | varies |
| Psychotherapy, 45 minutes (90834) range across 4 matching MRF lines |
$96.80–$278.85 | $176–$507 | varies |
| Psychotherapy, 60 minutes (90837) range across 3 matching MRF lines |
$90.75–$347.05 | $165–$631 | varies |
| Family psychotherapy, without patient (50 min) (90846) range across 2 matching MRF lines |
$119.35–$130.90 | $217–$238 | varies |
| Family psychotherapy, with patient (50 min) (90847) range across 2 matching MRF lines |
$118.80–$130.90 | $216–$238 | varies |
| Group psychotherapy (90853) range across 3 matching MRF lines |
$113.85–$124.30 | $207–$226 | varies |
| Sleep study (attended polysomnography) (95810) range across 2 matching MRF lines |
$3,214.20–$3,920.95 | $5,844–$7,129 | varies |
| Physical therapy, therapeutic exercise (per 15 min) (97110) | $68.75 | $125 | 2.4× |
| Office visit, new patient (low complexity, ~30 min) (99203) range across 2 matching MRF lines |
$65.45–$222.20 | $119–$404 | varies |
| Office visit, new patient (moderate complexity, ~45 min) (99204) range across 2 matching MRF lines |
$80.30–$260.15 | $146–$473 | varies |
| Office visit, new patient (high complexity, ~60 min) (99205) range across 2 matching MRF lines |
$91.85–$295.90 | $167–$538 | varies |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.
More prices at this hospital
- Imaging: 368 codes with posted prices and Medicare benchmarks
- Lab & pathology: 694 codes with posted prices and Medicare benchmarks
- Visits & medical services: 274 codes with posted prices and Medicare benchmarks
- Procedures & surgery: 609 codes with posted prices and Medicare benchmarks
- Supplies, drugs & other: 62 codes with posted prices and Medicare benchmarks
Get the raw price file
Download the machine-readable file (JSON, 40.8 MB) ↓ — captured 2026-09-08
File links point at the hospital's own hosting and sometimes rotate — if the download fails, use the hospital's transparency page.