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 |
|---|---|---|---|---|
| Quick disconn hook adapter o HCPCS L6628 | not published | not published | $525.64 – $1,352.66 | 4 |
| Quinupristin/dalfopristin HCPCS J2770 | not published | not published | $11.60 – $11.60 | 1 |
| Rabies ig heat-treated human im/subq 90376 CPT 90376 | not published | not published | $264.33 – $945.58 | 5 |
| Rabies ig ht&sol human im/sc CPT 90377 | not published | not published | $182.40 – $682.04 | 7 |
| Rabies immune globulin (pf) 300 unit/ml intramuscular solution CPT 90375 | not published | not published | $210.89 – $763.31 | 7 |
| Rabies vaccine id CPT 90676 | not published | not published | $177.64 – $720.03 | 5 |
| Radial keratotomy CPT 65771 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Radiation handling CPT 77790 | not published | not published | $49.43 – $49.43 | 1 |
| Radiation physics consult CPT 77336 | $554.40 | $1,008.00 | $99.71 – $256.58 | 4 |
| Radiation therapy dose plan CPT 77300 | $380.60 | $692.00 | $99.71 – $256.58 | 4 |
| Radiation therapy management CPT 77431 | not published | not published | $346.03 – $346.03 | 1 |
| Radiation treatment aid(s) CPT 77332 | $336.05 | $611.00 | $99.71 – $256.58 | 4 |
| Radiation treatment aid(s) CPT 77333 | $430.65 | $783.00 | $31.60 – $256.58 | 4 |
| Radiation treatment aid(s) CPT 77334 | $972.95 | $1,769.00 | $277.76 – $714.78 | 4 |
| Radiation treatment delivery CPT 77401 | not published | not published | $81.49 – $81.49 | 1 |
| Radiation treatment delivery CPT 77402 | $421.30 | $766.00 | $75.69 – $194.77 | 4 |
| Radiation treatment delivery CPT 77412 | $676.50 | $1,230.00 | $409.89 – $1,054.79 | 4 |
| Radiation tx management x5 CPT 77427 | not published | not published | $629.87 – $629.87 | 1 |
| Radical abdominal hysterectomy 58210 CPT 58210 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Radical rescj tumor clavicle CPT 23200 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Radical rescj tumor prox hum CPT 23220 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Radical rescj tumor scapula CPT 23210 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Radical resection of elbow CPT 24149 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Radical resection sternum 21630 CPT 21630 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Radic resect abd tumor<5cm 22904 CPT 22904 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Radic resect shoulder tumor 5cm/> 23078 CPT 23078 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Radiesse injection HCPCS Q2026 | not published | not published | $261.89 – $907.73 | 5 |
| Radiofq trsmtr for implt neu HCPCS L8683 | not published | not published | $4,976.71 – $12,806.73 | 4 |
| Radiof trsmtr implt scrl neu HCPCS L8684 | not published | not published | $780.91 – $2,009.54 | 4 |
| Radiology port images(s) CPT 77417 | $172.15 | $313.00 | $36.35 – $36.35 | 1 |
| Radiotherapy dose plan imrt CPT 77301 | $5,955.40 | $10,828.00 | $1,026.79 – $2,642.28 | 4 |
| Radium ra223 dichl ther/uci HCPCS A9606 | $156.75 | $285.00 | $136.16 – $459.31 | 5 |
| Radphm lcl tmr plnr bdy sgl day img CPT 78802 | $1,936.00 | $3,520.00 | $402.79 – $1,036.52 | 4 |
| Radphm lcl tmr plnr bdy two day img CPT 78804 | $2,524.50 | $4,590.00 | $402.79 – $1,036.52 | 4 |
| Radphm lcl tmr spect/ct 2+ areas/2+ days CPT 78831 | $2,660.90 | $4,838.00 | $960.41 – $2,471.46 | 4 |
| Radphm lcl tomogr sgl area sgl day CPT 78803 | $2,015.20 | $3,664.00 | $402.79 – $1,036.52 | 4 |
| Radphm lcl tumor plr sgl day CPT 78800 | $697.95 | $1,269.00 | $296.56 – $763.16 | 4 |
| Radphm quant measure sgl area add-on CPT 78835 | not published | not published | $268.64 – $268.64 | 1 |
| Rad rescj tum dstl/shft hum CPT 24150 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Rad rescj tum shoulder<5 cm CPT 23077 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Rad rescj tum tiss a/e 5 cm+ CPT 24079 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Rad rescj tum tiss a/e <5cm CPT 24077 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Rad resec soft tis tum/ft/toe/<3cm 28046 CPT 28046 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Rad resect abd tumor 5 cm/> CPT 22905 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Rad resect hand tumor < 3 cm CPT 26117 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Rad resect hand tumor 3 cm/> CPT 26118 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Rad resection tum radial h/n CPT 24152 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Rad resect tumor/neck/ant thor/<5cm21557 CPT 21557 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Ramucirumab 10 mg/ml intravenous solution HCPCS J9308 | not published | not published | $57.42 – $198.50 | 8 |
| Range of motion measurements CPT 95852 | not published | not published | $3.56 – $9.15 | 4 |
| Ranibizumab injection HCPCS J2778 | not published | not published | $38.32 – $337.54 | 8 |
| Rapid desensitization CPT 95180 | not published | not published | $331.39 – $852.79 | 4 |
| Rapid Strep Test CPT 87880 | $123.75 | $225.00 | $12.40 – $31.90 | 7 |
| Rasburicase 1.5 mg intravenous solution HCPCS J2783 | not published | not published | $290.59 – $1,007.24 | 8 |
| Ravulizumab-cwvz 100 mg/ml intravenous solution HCPCS J1303 | not published | not published | $170.19 – $600.55 | 8 |
| Rb82 rubidium HCPCS A9555 | not published | not published | $1,231.11 – $1,231.11 | 1 |
| Rbc count only automated CPT 85041 | $25.30 | $46.00 | $2.26 – $5.83 | 7 |
| Rbc deglycerolized each unit HCPCS P9039 | $435.05 | $791.00 | not published | 0 |
| Rbc depletion of harvest CPT 38212 | not published | not published | $327.28 – $2,334.00 | 6 |
| Rbc mechanical fragility CPT 85547 | not published | not published | $6.45 – $16.60 | 7 |
| Rbc osmotic fragility CPT 85555 | not published | not published | $5.60 – $14.42 | 7 |
| Rbc serum pretx incubj drugs CPT 86975 | $286.55 | $521.00 | $43.19 – $852.79 | 5 |
| Rcnst bfrnt sp orb rm&lw fhd CPT 21175 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rcnstj forehead w/autograft CPT 21180 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rcnstj forehead with grafts CPT 21179 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rcnstj mdfc lefort i 1 w/grf CPT 21145 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rcnstj mdfc lefort i 2 w/grf CPT 21146 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rcnstj mdfc lefort iii w/i CPT 21155 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rcnstj mdfc lefort iii without i CPT 21154 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rcnstj mdfc lefrtii w/b1 grf CPT 21151 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rcnst mdfc lfrtiii advm w/i CPT 21160 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rcnst mdfc lfrtiii advm wo i CPT 21159 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rdctj forehead cntrg only CPT 21137 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Rdctj forehead cntrg&prostc CPT 21138 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rdctj forehead cntrg&setback CPT 21139 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Realignment of knee CPT 27457 | not published | not published | $3,735.00 – $16,106.00 | 6 |
| Realignment of knee CPT 27455 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Realignment of tendons CPT 26437 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Realignment of thigh bone CPT 27454 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Rebuild eardrum structures CPT 69632 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rebuild eardrum structures CPT 69633 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rebuild eardrum structures CPT 69636 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rebuild outer ear canal CPT 69310 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rebuild outer ear canal CPT 69320 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rechanneling of artery CPT 35361 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Rechanneling of artery CPT 35306 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Rechanneling of artery CPT 35311 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Rechanneling of artery CPT 35363 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Rechanneling of artery 35305 CPT 35305 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Rechanneling of artery 35341 CPT 35341 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Rechanneling w/graft tibioperoneal trunk artery 35304 CPT 35304 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Rechanneling w/wo patch graft abd aorta 35331 CPT 35331 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Rechanneling w/wo patch graft deep profunda fem art 35372 CPT 35372 | $3,857.15 | $7,013.00 | $3,735.00 – $18,364.00 | 6 |
| Rechanneling w/wo patch grf axillary-brachial 35321 CPT 35303 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Recipient nephrectomy CPT 50340 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Recon, cta for surg plan HCPCS G0288 | not published | not published | $118.01 – $118.01 | 1 |
| Reconst lwr jaw w/fixation CPT 21196 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Reconst lwr jaw w/graft CPT 21194 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Reconst lwr jaw without fixation CPT 21195 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Reconst lwr jaw without graft CPT 21193 | 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.