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 |
|---|---|---|---|---|
| Resect hip tumor CPT 27075 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Resect hip tum w/innom bone CPT 27077 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Resect/incis/subva tissue/subva as 33415 CPT 33415 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Resect inferior turbinate CPT 30140 | not published | not published | $2,459.51 – $7,791.00 | 7 |
| Resection of elbow joint CPT 24155 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Resection palate/lesion 42120 CPT 42120 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Resect leg/ankle tum < 5 cm CPT 27615 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Resect leg/ankle tum 5 cm/> CPT 27616 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Resect mediastinal cyst 39200 CPT 39200 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Resect mediastinal tumor 39220 CPT 39220 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Resect metatarsal tumor CPT 28173 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Resect nasopharynx skull CPT 61586 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Resect neck tumor 5 cm/> CPT 21558 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Resect ovarian malignancy CPT 58952 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Resect ovarian malignancy w/bso 58950 CPT 58950 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Resect ovarian malignancy w/bso+omntc tah 58951 CPT 58951 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Resect part/compl phalangeal base ea 28126 CPT 28126 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Resect phalanx of toe tumor CPT 28175 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Resect prox finger tumor CPT 26260 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Resect radius/ulnar tumor CPT 25170 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Resect talus/calcaneus tum CPT 27647 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Resect tarsal tumor CPT 28171 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Resect thigh/knee tum < 5 cm CPT 27329 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Resect thigh/knee tum 5 cm/> CPT 27364 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Resect tibia tumor CPT 27645 | not published | not published | $2,427.27 – $18,364.00 | 6 |
| Reslizumab 10 mg/ml intravenous solution HCPCS J2786 | not published | not published | $8.80 – $28.10 | 8 |
| Respirator motion mgmt simul CPT 77293 | $1,619.20 | $2,944.00 | $1,213.35 – $1,213.35 | 1 |
| #resp virpnl dfa-adenovirus CPT 87260 | $32.45 | $59.00 | $10.82 – $27.85 | 7 |
| #resp virpnl dfa-parainfluenza CPT 87279 | $36.30 | $66.00 | $12.32 – $31.71 | 7 |
| Resp virus 6-11 targets CPT 87632 | $1,030.70 | $1,874.00 | $163.54 – $420.86 | 7 |
| Restore/remodelventricle 33548 CPT 33548 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Restorigin 1 sq cm HCPCS Q4191 | not published | not published | $92.32 – $2,766.90 | 7 |
| Resuscitation cardiopulmonary CPT 92950 | $669.90 | $1,218.00 | $160.18 – $2,334.00 | 6 |
| Resuscitation delivery/birthing room CPT 99465 | not published | not published | $490.31 – $1,261.73 | 4 |
| Reteplase injection HCPCS J2993 | not published | not published | $7,560.76 – $7,560.76 | 1 |
| Reticulated platelet assay CPT 85055 | not published | not published | $26.80 – $68.98 | 7 |
| Reticulocyte automated CPT 85045 | $34.65 | $63.00 | $2.99 – $7.70 | 7 |
| Reticulocyte direct measurement automated CPT 85046 | not published | not published | $4.18 – $10.75 | 7 |
| Retifanlimab-dlwr 500 mg/20 ml intravenous solution HCPCS J9345 | not published | not published | $23.24 – $79.66 | 8 |
| Retr bone flap to fix skull CPT 62148 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Retrieval of oocyte CPT 58970 | not published | not published | $683.26 – $3,030.00 | 6 |
| Retrograde ejaculation anal CPT 89331 | not published | not published | $14.69 – $37.81 | 7 |
| Reusable nipple prosthesis HCPCS L8032 | not published | not published | $36.17 – $93.08 | 4 |
| Revasc evasc fpvt angio cplx 1st CPT 37265 | not published | not published | $4,222.18 – $10,865.09 | 4 |
| Revasc evasc fpvt angio sf 1st CPT 37263 | not published | not published | $4,222.18 – $10,865.09 | 4 |
| Revasc evasc fpvt athrec cplx 1st CPT 37273 | not published | not published | $13,599.00 – $34,994.75 | 4 |
| Revasc evasc fpvt athrec sf 1st CPT 37271 | not published | not published | $13,599.00 – $34,994.75 | 4 |
| Revasc evasc fpvt st athrec sf 1st CPT 37275 | not published | not published | $13,599.00 – $34,994.75 | 4 |
| Revasc evasc fpvt stent cplx 1st CPT 37269 | not published | not published | $8,563.85 – $22,037.64 | 4 |
| Revasc evasc fpvt stent sf 1st CPT 37267 | not published | not published | $8,563.85 – $22,037.64 | 4 |
| Revasc evasc imvt angio cplx 1st CPT 37298 | not published | not published | $8,563.85 – $22,037.64 | 4 |
| Revasc evasc imvt angio sf 1st CPT 37296 | not published | not published | $8,563.85 – $22,037.64 | 4 |
| Revasc evasc ivt angio cplx 1st CPT 37256 | not published | not published | $4,222.18 – $10,865.09 | 4 |
| Revasc evasc ivt stent cplx 1st CPT 37260 | not published | not published | $8,563.85 – $22,037.64 | 4 |
| Revasc evasc ivt stent sf 1st CPT 37258 | not published | not published | $8,563.85 – $22,037.64 | 4 |
| Revasc evasc tpvt angio cplx 1st CPT 37282 | not published | not published | $8,563.85 – $22,037.64 | 4 |
| Revasc evasc tpvt angio sf 1st CPT 37280 | not published | not published | $8,563.85 – $22,037.64 | 4 |
| Revasc evasc tpvt athrec cplx 1st CPT 37290 | not published | not published | $13,599.00 – $34,994.75 | 4 |
| Revasc evasc tpvt athrec sf 1st CPT 37288 | not published | not published | $13,599.00 – $34,994.75 | 4 |
| Revasc intra lithotrip-ather HCPCS C9766 | not published | not published | $7,609.00 – $34,994.75 | 6 |
| Revasc intra lithotrip-stent HCPCS C9765 | $17,672.05 | $32,131.00 | $7,609.00 – $34,994.75 | 6 |
| Revasc intravasc lithotripsy HCPCS C9764 | $17,074.20 | $31,044.00 | $6,019.00 – $22,037.64 | 6 |
| Revasc lithotr-ather tib/per HCPCS C9774 | not published | not published | $13,599.00 – $34,994.75 | 6 |
| Revasc lithotrip-stent-ather HCPCS C9767 | not published | not published | $8,923.00 – $34,994.75 | 6 |
| Revasc lithotrip tibi/perone HCPCS C9772 | $14,318.70 | $26,034.00 | $8,563.85 – $27,583.00 | 6 |
| Revasc lithotr-stent tib/per HCPCS C9773 | not published | not published | $13,599.00 – $34,994.75 | 6 |
| Revasc lith-sten-ath tib/per HCPCS C9775 | not published | not published | $13,599.00 – $34,994.75 | 6 |
| Revascularization penis CPT 37788 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Revefenacin inh non-com 1mcg HCPCS J7677 | not published | not published | $0.22 – $0.54 | 5 |
| Revise abdomen-venous shunt CPT 49426 | not published | not published | $2,656.06 – $8,770.00 | 6 |
| Revise additional leg tendon CPT 27692 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Revise aqueous shunt eye CPT 66185 | not published | not published | $1,712.02 – $7,791.00 | 6 |
| Revise arm/leg nerve CPT 64708 | not published | not published | $1,448.59 – $7,791.00 | 6 |
| Revise bladder & ureter(s) CPT 51565 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Revise breast reconst 19380 CPT 19380 | not published | not published | $4,925.89 – $16,106.00 | 6 |
| Revise circulation to head CPT 61708 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Revise circulation to head CPT 61705 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Revise circulation to head CPT 61710 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Revise esophagus & stomach 43325 CPT 43325 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Revise eye CPT 65091 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Revise eyelashes CPT 67825 | not published | not published | $235.46 – $2,334.00 | 6 |
| Revise eyelashes CPT 67835 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Revise eyelid defect CPT 67909 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Revise eyelid defect CPT 67911 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Revise eyelid lining CPT 68330 | not published | not published | $1,712.02 – $7,791.00 | 6 |
| Revise eyelid lining CPT 68360 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Revise eyelid lining CPT 68362 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Revise eye muscle CPT 67311 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Revise eye muscle CPT 67314 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Revise eye muscle add-on CPT 67340 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Revise eye muscle(s) CPT 67318 | not published | not published | $1,763.69 – $7,791.00 | 6 |
| Revise eye muscle(s) add-on CPT 67320 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Revise eye muscle w/suture CPT 67334 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Revise eye socket implant CPT 67560 | not published | not published | $2,916.44 – $8,770.00 | 6 |
| Revise eye sockets CPT 21260 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Revise eye sockets CPT 21261 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Revise eye sockets CPT 21263 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Revise eye sockets CPT 21267 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Revise eye sockets CPT 21268 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Revise eye with implant CPT 65093 | not published | not published | $2,916.44 – $8,770.00 | 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.