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 |
|---|---|---|---|---|
| Re-exploration of chest 32120 CPT 32120 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Reexploration pelvic wound 49014 CPT 49014 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Re-explore parathyroids CPT 60502 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Refill maint impl spine pump CPT 95991 | $509.30 | $926.00 | $227.71 – $2,334.00 | 6 |
| Refill/maint pump/resvr syst CPT 96522 | $308.55 | $561.00 | $157.79 – $406.05 | 4 |
| Regadenoson 0.4 mg/5 ml intravenous syringe HCPCS J2785 | not published | not published | $4.12 – $10.38 | 5 |
| Reimplant artery each 35697 CPT 35697 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Reimplant ureter in bladder CPT 50782 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Reimplant ureter in bladder CPT 50783 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Reimplant ureter in bladder CPT 50785 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Reinforce clavicle CPT 23490 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Reinforced solid stirrup HCPCS L2260 | not published | not published | $172.76 – $444.58 | 4 |
| Reinforce eye wall CPT 67250 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Reinforce/graft eye wall CPT 67255 | not published | not published | $3,066.31 – $7,890.63 | 6 |
| Reinforce hip bones CPT 27187 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Reinforce shoulder bones CPT 23491 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Reinforce thigh CPT 27495 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Reinforce tibia CPT 27745 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Reinnervate larynx CPT 31590 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Reinsertion of spinal fixation device 22849 CPT 22849 | not published | not published | $3,388.00 – $27,583.00 | 6 |
| Reinsert ocular implant CPT 65155 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Release encircling material CPT 67115 | not published | not published | $3,066.31 – $7,890.63 | 6 |
| Release eye tissue CPT 67343 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Release facial nerve CPT 69720 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Release facial nerve CPT 69725 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Release facial nerve CPT 69955 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Release finger contracture CPT 26525 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Release forearm/hand tendon CPT 26449 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Release inner ear canal CPT 69960 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Release knuckle contracture CPT 26520 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Release middle ear bone CPT 69650 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Release muscles of hand CPT 26593 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Release of eye fluid CPT 67015 | not published | not published | $1,712.02 – $7,791.00 | 6 |
| Release of foot tendon CPT 28220 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Release of foot tendon 28225 CPT 28225 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Release of foot tendons CPT 28222 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Release of foot tendons CPT 28226 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Release of lower leg tendon CPT 27680 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Release of lower leg tendons CPT 27681 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Release of lung 32220 CPT 32220 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Release of midfoot joint CPT 28260 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Release of midfoot joint CPT 28264 | not published | not published | $1,192.86 – $18,364.00 | 6 |
| Release of shoulder ligament CPT 23415 | not published | not published | $5,382.89 – $16,106.00 | 6 |
| Release of skull seams CPT 61550 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Release of skull seams CPT 61552 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Release of ureter CPT 50715 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Release of ureter CPT 50722 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Release of ureter CPT 50940 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Release palm contracture CPT 26040 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Release palm contracture CPT 26121 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Release palm contracture CPT 26123 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Release palm contracture CPT 26125 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Release palm contracture 26045 CPT 26045 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Release palm & finger tendon CPT 26442 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Release palm/finger tendon CPT 26440 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Release/revise ureter CPT 50725 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Release spinal cord lumbar CPT 63200 | not published | not published | $6,779.00 – $27,583.00 | 3 |
| Release thumb contracture CPT 26508 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Release wrist/forearm tendon CPT 25295 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Relieve bladder contracture CPT 52640 | not published | not published | $2,614.94 – $7,791.00 | 6 |
| Relieve cranial pressure 61345 CPT 61345 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Relocation of testis(es) CPT 54680 | not published | not published | $2,614.94 – $7,791.00 | 6 |
| Relocation skin pocket aicd CPT 33223 | $1,938.20 | $3,524.00 | $1,530.61 – $4,761.00 | 6 |
| Relocation skin pocket pm CPT 33222 | $1,938.20 | $3,524.00 | $1,530.61 – $4,761.00 | 6 |
| Rem/biv cast full arm/leg CPT 29705 | $520.30 | $946.00 | $207.48 – $2,334.00 | 6 |
| Rem/biv cast shldr/hip spica CPT 29710 | not published | not published | $207.48 – $2,334.00 | 6 |
| Remdesivir 100 mg intravenous powder for solution HCPCS J0248 | not published | not published | $5.63 – $17.29 | 8 |
| Rem endovas vena cava filter CPT 37193 | $2,902.35 | $5,277.00 | $2,342.32 – $8,770.00 | 6 |
| Rem interrog dev eval icpms CPT 93297 | not published | not published | $27.69 – $71.25 | 4 |
| Rem interrog dev eval scrms CPT 93298 | $168.30 | $306.00 | $27.69 – $71.25 | 4 |
| Rem interrog evl pm/ids CPT 93296 | $160.05 | $291.00 | $27.69 – $71.25 | 4 |
| Rem interrog evl pm/ldls pm CPT 93294 | $66.00 | $120.00 | not published | 0 |
| Rem mntr physiol 1st dev supply ea 30 days CPT 99454 | not published | not published | $27.69 – $71.25 | 4 |
| Rem mntr physiol 1st set up pt educaj eqp CPT 99453 | not published | not published | $98.76 – $254.15 | 4 |
| Rem mntr wrls p-art prs snr CPT 93264 | not published | not published | $27.69 – $71.25 | 4 |
| Remote 30 day ecg tech supp CPT 93229 | not published | not published | $276.82 – $712.35 | 4 |
| Remot img sub by pt, non e/m HCPCS G2250 | not published | not published | $5.78 – $14.88 | 4 |
| Removable insert each HCPCS L6691 | not published | not published | $324.66 – $835.46 | 4 |
| Removable soft interface le HCPCS K0672 | not published | not published | $78.16 – $201.14 | 4 |
| Removal abdomen lymph nodes 38564 CPT 38564 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Removal allograft pancreas CPT 48556 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Removal anal seton other marker 46030 CPT 46030 | not published | not published | $887.71 – $4,761.00 | 6 |
| Removal biliary drg cath CPT 47537 | $1,322.75 | $2,405.00 | $672.83 – $4,761.00 | 6 |
| Removal central venous catheter tunneled without port/pump CPT 36589 | $1,000.45 | $1,819.00 | $465.35 – $3,030.00 | 6 |
| Removal central venous device tunneled w/port/pump central/peripheral insertion CPT 36590 | $2,441.45 | $4,439.00 | $1,167.76 – $4,761.00 | 6 |
| Removal cerclage w/anes CPT 59871 | not published | not published | $2,401.40 – $8,770.00 | 6 |
| Removal cerclage without anes CPT 59899 | not published | not published | $149.98 – $2,334.00 | 6 |
| Removal cerumen impacted (both sides) CPT 69210 | $210.10 | $382.00 | $43.76 – $2,334.00 | 6 |
| Removal clot in graft oth/thn 35875 CPT 35875 | not published | not published | $4,127.91 – $18,364.00 | 6 |
| Removal clot in graft xcp 35876 CPT 35876 | not published | not published | $4,127.91 – $18,364.00 | 6 |
| Removal deep drug delivery device CPT 20701 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Removal devitalized tissue non-selective debridement without anesthesia per session CPT 97602 | $170.50 | $310.00 | $148.84 – $383.01 | 4 |
| Removal duct glbldr calculi CPT 47544 | $3,658.60 | $6,652.00 | $1,887.00 – $5,512.00 | 3 |
| Removal embedded foreign body vestibule mouth smpl CPT 40804 | $1,793.55 | $3,261.00 | $672.83 – $4,761.00 | 6 |
| Removal foreign body extrn auditory canal with anes CPT 69205 | not published | not published | $1,225.21 – $4,761.00 | 6 |
| Removal foreign body foot cmplx CPT 28193 | not published | not published | $1,225.21 – $3,152.87 | 6 |
| Removal foreign body foot subcutaneous right CPT 28190 | $1,354.10 | $2,462.00 | $525.32 – $3,030.00 | 6 |
| Removal foreign body gum 41805 CPT 41805 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Removal foreign body jawbone CPT 41806 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Removal foreign body mouth CPT 40805 | not published | not published | $400.09 – $2,334.00 | 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.