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 |
|---|---|---|---|---|
| Rev/rmvl gstr nstim eltrd CPT 43882 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Rev/rmv perph nstim eltrd ra CPT 64585 | not published | not published | $2,593.52 – $8,770.00 | 6 |
| Rev/rmv prph sac/gstr npg/r CPT 64595 | not published | not published | $2,593.52 – $8,770.00 | 6 |
| Rev rplcm arthrp 1ntrspc crv CPT 22861 | not published | not published | $6,779.00 – $33,471.73 | 6 |
| Rev rplcm rthrp 1ntrspc lmbr CPT 22862 | not published | not published | $6,779.00 – $33,471.73 | 6 |
| Rev/rplcmt sk-mnt crnl nstm CPT 61891 | not published | not published | $8,923.00 – $58,906.76 | 5 |
| Rev rplc/rmv thrc vrt tethrg CPT 22838 | not published | not published | $6,779.00 – $33,471.73 | 4 |
| Rev/rplct hpglsl nstm ary pg CPT 64583 | not published | not published | $7,609.00 – $27,583.00 | 6 |
| Revsc opn/prq tib/pero stent CPT 37234 | $9,196.55 | $16,721.00 | $5,512.00 – $18,364.00 | 3 |
| Rezafungin 200 mg intravenous solution HCPCS J0349 | not published | not published | $8.25 – $28.36 | 8 |
| Rf abltj nrv nrvtg si jt CPT 64625 | $1,712.70 | $3,114.00 | $1,448.59 – $7,791.00 | 6 |
| Rheumatoid factor qualitative CPT 86430 | not published | not published | $4.60 – $11.85 | 7 |
| Rheumatoid factor quantitative CPT 86431 | $50.05 | $91.00 | $4.25 – $10.94 | 7 |
| Rh ig IV CPT 90386 | not published | not published | $1,804.28 – $1,804.28 | 1 |
| Rh ig minidose im CPT 90385 | not published | not published | $60.00 – $164.06 | 5 |
| Rhinp prim lat&alr crtlge&/elvtn nsl tip CPT 30400 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe HCPCS J2791 | not published | not published | $5.30 – $13.32 | 5 |
| Rho d immune globulin 50 mcg HCPCS J2788 | not published | not published | $25.98 – $66.86 | 5 |
| Rho(d) immune globulin h, sd HCPCS J2792 | not published | not published | $26.84 – $89.46 | 8 |
| Rho d immune globulin inj HCPCS J2790 | not published | not published | $84.88 – $226.94 | 5 |
| Rho(d) immune globulin (rhig) human full dose im CPT 90384 | not published | not published | $326.16 – $326.16 | 1 |
| R hrt cath chd abnl nt cnj CPT 93594 | not published | not published | $2,404.97 – $16,106.00 | 6 |
| R hrt cath chd nml nt cnj CPT 93593 | not published | not published | $2,404.97 – $16,106.00 | 6 |
| Rib cartilage graft CPT 21230 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Rib gusset (elastic) each HCPCS L1280 | not published | not published | $80.54 – $207.26 | 4 |
| Riboflavin 5'phos opth<=3ml HCPCS J2787 | not published | not published | $7,448.76 – $7,448.76 | 1 |
| Rifampin in ns IV syringe 3 mg/ml (neo/ped) - cnr HCPCS J2804 | not published | not published | $0.15 – $0.30 | 2 |
| Right ventric recording CPT 93603 | $1,256.20 | $2,284.00 | $903.21 – $4,761.00 | 6 |
| Rilonacept injection HCPCS J2793 | not published | not published | $73.51 – $73.51 | 1 |
| Ring flange plas/leather mol HCPCS L1110 | not published | not published | $293.48 – $755.23 | 4 |
| Ring flange plastic/leather HCPCS L1100 | not published | not published | $175.04 – $450.44 | 4 |
| Ring fx reform 11-13x17mm HCPCS L8610 | $347.06 | $631.01 | not published | 0 |
| Risankizumab-rzaa 60 mg/ml intravenous solution HCPCS J2327 | not published | not published | $10.90 – $41.05 | 8 |
| Risk ascvd tst once pr 12 mo HCPCS G0537 | not published | not published | $27.80 – $71.53 | 4 |
| Risperidone microspheres 12.5 mg/2 ml inj HCPCS J2794 | not published | not published | $8.33 – $29.91 | 8 |
| Rituximab 10 mg/ml concentrate,intravenous HCPCS J9312 | not published | not published | $54.96 – $208.89 | 8 |
| Rituximab 1,400 mg/11.7 ml (120 mg/ml)-hyaluronidase subcutaneous soln HCPCS J9311 | not published | not published | $27.29 – $99.59 | 8 |
| Rituximab-abbs 10 mg/ml intravenous solution HCPCS Q5115 | not published | not published | $25.92 – $86.66 | 7 |
| Rituximab-arrx 10 mg/ml intravenous solution HCPCS Q5123 | not published | not published | $13.90 – $100.14 | 7 |
| Rituximab-pvvr 10 mg/ml intravenous solution HCPCS Q5119 | not published | not published | $12.12 – $64.22 | 7 |
| R&l hrt cath chd abnl nt cnj CPT 93597 | not published | not published | $2,404.97 – $16,106.00 | 6 |
| R&l hrt cath chd nml nt cnj CPT 93596 | not published | not published | $2,404.97 – $16,106.00 | 6 |
| Rmv anterior spine instrumentation 22855 CPT 22855 | not published | not published | $3,388.00 – $18,364.00 | 6 |
| Rmv implant contraceptive capsule 11976 CPT 11976 | not published | not published | $525.32 – $3,030.00 | 6 |
| Rmvl esophgl sphnctr dev CPT 43285 | not published | not published | $4,484.77 – $18,364.00 | 6 |
| Rmvl ext fixj sys under anes CPT 20694 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Rmvl fb upr arm/elbow deep CPT 24201 | not published | not published | $2,154.81 – $5,545.05 | 6 |
| Rmvl fecal impaction/fb spx under anes CPT 45915 | not published | not published | $887.71 – $4,761.00 | 6 |
| Rmvl foreign body upper arm/elbow subcutaneous CPT 24200 | $3,025.55 | $5,501.00 | $1,225.21 – $3,152.87 | 6 |
| Rmvl hpglsl nstim ary pg CPT 64584 | not published | not published | $2,534.21 – $18,364.00 | 6 |
| Rmvl i-artic rx delivery dev 20705 CPT 20705 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Rmvl icd by tv extr CPT 33244 | $2,292.40 | $4,168.00 | $2,772.20 – $8,770.00 | 6 |
| Rmvl icd gen w/rplc icd gen dual lead sys CPT 33263 | $23,954.15 | $43,553.00 | $8,923.00 – $54,996.00 | 6 |
| Rmvl icd gen w/rplc icd gen mlt lead sys CPT 33264 | $21,447.80 | $38,996.00 | $8,923.00 – $59,920.75 | 6 |
| Rmvl icd gen w/rplc icd gen sgl lead sys CPT 33262 | $20,149.25 | $36,635.00 | $8,923.00 – $54,996.00 | 6 |
| Rmvl icd pulse gen only CPT 33241 | $2,473.90 | $4,498.00 | $2,772.20 – $8,770.00 | 6 |
| Rmvl imed rx delivery device CPT 20703 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Rmvl left heart vent thor inscn ecmo CPT 33989 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Rmvl lung xcp tot pneumonectomy sleeve lob 32486 CPT 32486 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Rmvl ndwellg tun pleural cath CPT 32552 | $595.10 | $1,082.00 | $465.35 – $3,030.00 | 6 |
| Rmvl ninfct mesh hernia rpr 49623 CPT 49623 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Rmvl perm pm pulse gen CPT 33233 | $5,046.80 | $9,176.00 | $6,138.95 – $15,797.56 | 6 |
| Rmvl phrnc nrv stim pg only CPT 33280 | not published | not published | $2,593.52 – $8,657.00 | 5 |
| Rmvl phrnc nrv stim sys CPT 33278 | not published | not published | $2,593.52 – $8,657.00 | 5 |
| Rmvl phrnc nrv stim transvns CPT 33279 | not published | not published | $2,593.52 – $8,657.00 | 5 |
| Rmvl pm gen w/rplc pm gen mlt lead sys CPT 33229 | $6,551.60 | $11,912.00 | $8,923.00 – $36,770.21 | 6 |
| Rmvl pm gen w/rplc pm gen sgl lead sys CPT 33227 | $5,071.00 | $9,220.00 | $6,138.95 – $27,583.00 | 6 |
| Rmvl pq iabp CPT 33968 | $1,082.40 | $1,968.00 | $3,735.00 – $44,873.00 | 3 |
| Rmvl pq vad left hrt vein sep session CPT 33992 | $2,542.65 | $4,623.00 | $7,609.00 – $7,609.00 | 1 |
| Rmvl prosthhumrl&ulnar cmpnt CPT 24160 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Rmvl rplcmt hrt sys f/trnspl CPT 33929 | not published | not published | $8,923.00 – $8,923.00 | 1 |
| Rmvl & rplcmt tot hrt sys CPT 33928 | not published | not published | $8,923.00 – $8,923.00 | 1 |
| Rmvl sq defib electrode CPT 33272 | $2,694.45 | $4,899.00 | $2,772.20 – $8,770.00 | 6 |
| Rmvl subq card rhythm mntr CPT 33286 | $893.75 | $1,625.00 | $525.32 – $3,030.00 | 6 |
| Rmvl tiss expndr without implant insrtn CPT 11971 | not published | not published | $2,154.81 – $7,791.00 | 6 |
| Rmvl tongs/halo anthr indiv CPT 20665 | not published | not published | $331.39 – $2,334.00 | 6 |
| Rmvl tot arthrp 1ntrspc crv CPT 22864 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Rmvl tot arthrp 1ntrspc lmbr CPT 22865 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Rmvl transplanted rnl algrft CPT 50370 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Rmvl tv pm lead dual CPT 33235 | $1,855.15 | $3,373.00 | $2,772.20 – $8,770.00 | 6 |
| Rmvl tv pm lead sgl CPT 33234 | $2,152.70 | $3,914.00 | $2,772.20 – $8,770.00 | 6 |
| Rmv ntr oi implt skl prq esp CPT 69726 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Rmv ntr oi imp sk tc>=100 CPT 69728 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Rmv ntr oi imp sk tc esp<100 CPT 69727 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Rmv prosth mat/mesh/abd wall/infec 11008 CPT 11008 | not published | not published | $2,654.00 – $8,770.00 | 3 |
| Rmv&rplcmt phrnc nrv stim ld CPT 33288 | not published | not published | $7,609.00 – $27,583.00 | 5 |
| Rmv&rplcmt phrnc nrv stim pg CPT 33287 | not published | not published | $8,923.00 – $58,906.76 | 5 |
| Rmv sk-mnt crnl nstm pg/rcvr CPT 61892 | not published | not published | $2,427.27 – $8,657.00 | 5 |
| Rnl altrnsplj without rcp nfrct CPT 50360 | not published | not published | $8,923.00 – $8,923.00 | 1 |
| Rnl altrnsplj w/rcp nfrct CPT 50365 | not published | not published | $8,923.00 – $8,923.00 | 1 |
| Rnl autotrnsplj rimpltj kdn CPT 50380 | not published | not published | $8,923.00 – $8,923.00 | 1 |
| Robot lin-radsurg com, first HCPCS G0339 | not published | not published | $15,691.00 – $16,106.00 | 2 |
| Robt lin-radsurg fractx 2-5 HCPCS G0340 | not published | not published | $8,657.00 – $8,770.00 | 2 |
| Rocker bottom, contact afo HCPCS L2232 | not published | not published | $89.54 – $230.40 | 4 |
| Rolapitant, oral, 1mg HCPCS J8670 | not published | not published | $1.75 – $4.41 | 5 |
| Romidepsin 10 mg/2 ml intravenous powder for solution HCPCS J9319 | not published | not published | $23.03 – $82.73 | 8 |
| Romiplostim 125 mcg subcutaneous solution HCPCS J2802 | not published | not published | $8.71 – $28.69 | 8 |
| Romosozumab-aqqg 105 mg/1.17 ml subcutaneous syringe (wrapper) HCPCS J3111 | not published | not published | $9.55 – $31.28 | 8 |
| Ropivacaine 0.2 % epidural pca - 1 hour dose limit HCPCS J2795 | not published | not published | $0.07 – $0.20 | 5 |
| Rotation wrst with cable lock HCPCS L6625 | not published | not published | $488.33 – $1,256.64 | 4 |
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.