SSM Health St. Agnes Hospital - Fond du Lac prices. From its own published file.

SSM Health St. Agnes Hospital - Fond du Lac in Fond Du Lac, WI publishes its standard charges as required by federal rule. Here's what it lists for common services, and how to check your bill against it.

13,799prices published

Apr 2026file last updated

$2,257cash price for mri lower back without contrast (list $4,104)

Common services

Service	Cash price	List price	Insurers pay
Emergency visit, moderate (level 3) `99283`	$240	$713	$203–$521
Emergency visit, high (level 4) `99284`	$358	$1,842	$310–$797
Emergency visit, highest (level 5) `99285`	$523	$1,755	$442–$1,137
Comprehensive metabolic panel `80053`	$133	$241	$7.92–$21.40
Basic metabolic panel `80048`	$97.35	$180	$6.34–$17.11
Complete blood count (CBC) `85025`	$75.35	$137	$5.83–$15.72
Blood draw (venipuncture) `36415`	$20.90	$38.00	$3.00–$18.03
Urinalysis `81001`	$57.75	$105	$2.38–$6.41
Troponin (heart test) `84484`	$87.45	$159	$9.35–$24.07
EKG tracing `93005`	$172	$312	$43.76–$113
Chest X-ray, 2 views `71046`	$261	$475	$64.56–$166
CT head without contrast `70450`	$1,375	$2,500	$77.56–$251
CT abdomen and pelvis with contrast `74177`	$1,713	$3,115	$259–$755
MRI lower back without contrast `72148`	$2,257	$4,104	$177–$508
Ultrasound, abdomen `76700`	$674	$1,226	$77.56–$285
IV push, single drug `96374`	$186	$363	$158–$406
IV fluids, first hour `96360`	$255	$499	$158–$574
Ketorolac injection, 15 mg `J1885`	—	—	$0.21–$2.05
Ondansetron injection `J2405`	—	—	$0.09–$0.25
Colonoscopy, diagnostic `45378`	—	—	$690–$4,761
Upper GI endoscopy with biopsy `43239`	—	—	$673–$4,761
Knee arthroscopy `29881`	—	—	$2,427–$8,770
Vaginal delivery, routine care `59400`	—	—	$3,735–$4,589
Cesarean delivery, routine care `59510`	—	—	$3,735–$4,589

Cash price: the discounted price for self-pay patients. List price: the hospital's gross charge. Insurers pay: the lowest and highest rates it lists for insurance plans. Source: SSM Health St. Agnes Hospital - Fond du Lac price transparency page.

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Common billing problems to look for

Billed above the posted cash priceIf you're paying yourself, ask the hospital to apply its published cash price.
Panels billed inside panelsA basic metabolic panel (80048) billed with a comprehensive one (80053) on the same day.
Duplicate linesThe same service billed twice without explanation.
No itemized billYou can ask for every line with its code, date and amount.