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 |
|---|---|---|---|---|
| Tetanus immune globulin inj HCPCS J1670 | not published | not published | $446.26 – $1,557.47 | 8 |
| Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe HCPCS J2356 | not published | not published | $13.44 – $49.43 | 8 |
| Tgfbi gene common variants CPT 81333 | not published | not published | $102.75 – $264.41 | 7 |
| Tgsap hl neo 5-50 rna alys CPT 81451 | not published | not published | $569.65 – $1,465.89 | 7 |
| Tgsap so/hl 51/< rna alys CPT 81456 | not published | not published | $2,189.70 – $5,634.83 | 7 |
| Tgsap so neo 5-50 rna alys CPT 81449 | not published | not published | $448.43 – $1,153.97 | 7 |
| Thaw cryoprsvrd reprod tiss CPT 89354 | not published | not published | $126.39 – $325.23 | 5 |
| Thawing cryopresrved embryo CPT 89352 | not published | not published | $126.39 – $325.23 | 5 |
| Thawing cryopresrved oocyte CPT 89356 | not published | not published | $126.39 – $325.23 | 5 |
| Thawing cryopresrved sperm CPT 89353 | not published | not published | $38.66 – $99.48 | 5 |
| Thaw preserved stem cells CPT 38208 | not published | not published | $327.28 – $2,334.00 | 6 |
| Theophylline therapeutic drug level CPT 80198 | $121.00 | $220.00 | $10.60 – $27.29 | 7 |
| Therapeutic procd strg endur HCPCS G0237 | $49.50 | $90.00 | $21.46 – $55.21 | 4 |
| Therapy activity per session >= 45 minutes HCPCS G0176 | $81.95 | $149.00 | not published | 0 |
| Therapy nutrition individual initial f2f w/patient each 15 minutes CPT 97802 | $65.45 | $119.00 | $19.35 – $49.79 | 4 |
| Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes CPT 97803 | $53.90 | $98.00 | $16.15 – $41.55 | 4 |
| Therapy photodnmc lght dstr lsn skn by staff rx per day CPT 96567 | not published | not published | $148.84 – $2,334.00 | 6 |
| Ther fx nasal inf turbinate CPT 30930 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Ther nma rdctj intus/obstrcj CPT 74283 | $365.20 | $664.00 | $130.12 – $334.84 | 4 |
| Ther/proph/diag inj ia CPT 96373 | $105.60 | $192.00 | $157.79 – $406.05 | 4 |
| Ther radiology tx plng cplx CPT 77263 | not published | not published | $562.52 – $562.52 | 1 |
| Ther radiology tx plng intrm CPT 77262 | not published | not published | $384.77 – $384.77 | 1 |
| Ther radiology tx plng smpl CPT 77261 | not published | not published | $257.70 – $257.70 | 1 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | not published | not published | $1.91 – $4.79 | 5 |
| Thiethylperazine maleate inj HCPCS J3280 | not published | not published | $12.33 – $12.33 | 1 |
| Thigh/wght bear high roll cu HCPCS L2550 | not published | not published | $313.62 – $807.05 | 4 |
| Thigh/wght bear lacer molded HCPCS L2540 | not published | not published | $418.28 – $1,076.36 | 4 |
| Thigh/wght bear lacer non-mo HCPCS L2530 | not published | not published | $221.05 – $568.83 | 4 |
| Thi/glut/ischia wgt bearing HCPCS L2500 | not published | not published | $288.44 – $742.24 | 4 |
| Thiotepa injection HCPCS J9340 | not published | not published | $240.10 – $603.72 | 4 |
| Thorabd diaphr hern repair CPT 43336 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thorabd diaphr hern repair CPT 43337 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thorac cont lat support upri HCPCS L2680 | not published | not published | $134.86 – $347.05 | 4 |
| Thorac cont paraspinal uprig HCPCS L2670 | not published | not published | $147.02 – $378.32 | 4 |
| Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) CPT 32555 | $1,724.25 | $3,135.00 | $465.35 – $3,030.00 | 6 |
| Thoracic aortic graft 33875 CPT 33875 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Thoracic control thoracic ba HCPCS L2660 | not published | not published | $165.15 – $424.99 | 4 |
| Thoracic duct procedure CPT 38380 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Thoracic duct procedure CPT 38381 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Thoracic duct procedure CPT 38382 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Thoracic intern lock elbow HCPCS L6350 | not published | not published | $4,491.54 – $11,558.23 | 4 |
| Thoracic lymphadenect/thoracotomy 38746 CPT 38746 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracic pad HCPCS L1060 | not published | not published | $99.82 – $256.88 | 4 |
| Thoracoabdominal graft 33877 CPT 33877 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Thoracoscop w/esoph musc exc CPT 32665 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracoscopy bilobectomy 32670 CPT 32670 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracoscopy diagnostic 32601 CPT 32601 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Thoracoscopy for lvrs CPT 32672 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracoscopy lymph node exc CPT 32674 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracoscopy pneumonectomy CPT 32671 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracoscopy remove cortex CPT 32651 | not published | not published | $5,257.00 – $27,583.00 | 3 |
| Thoracoscopy remove segment CPT 32669 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracoscopy remov fb/fibrin 32653 CPT 32653 | not published | not published | $5,257.00 – $18,364.00 | 3 |
| Thoracoscopy resect bullae 32655 CPT 32655 | not published | not published | $5,257.00 – $27,583.00 | 3 |
| Thoracoscopy surgical 32650 CPT 32650 | not published | not published | $5,257.00 – $27,583.00 | 3 |
| Thoracoscopy surgical with control of traumatic hemorrhage CPT 32654 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracoscopy/thoracic sympathectomy32664 CPT 32664 | not published | not published | $5,257.00 – $8,770.00 | 3 |
| Thoracoscopy/tot pulm decortication32652 CPT 32652 | not published | not published | $5,257.00 – $27,583.00 | 3 |
| Thoracoscopy w/bx med space CPT 32606 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Thoracoscopy wbx sac CPT 32604 | not published | not published | $5,257.00 – $20,292.15 | 6 |
| Thoracoscopy w/lobectomy CPT 32663 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracoscopy w/mediast exc CPT 32662 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracoscopy w/pericard exc CPT 32661 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracoscopy w/pleurectomy 32656 CPT 32656 | not published | not published | $5,257.00 – $27,583.00 | 3 |
| Thoracoscopy w/sac drng 32659 CPT 32659 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracoscopy w/sac fb remove CPT 32658 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracoscopy w/thymus resect CPT 32673 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracoscopy w/wedge resect CPT 32666 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Thoracoscopy w w resect addl 32667 CPT 32667 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracoscopy w w resect diag 32668 CPT 32668 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracostomy w/flap drng 32036 CPT 32036 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracostomy w/rib resection 32035 CPT 32035 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Thoracotomy opn free adhesions 32124 CPT 32124 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Thoracotomy w/expl CPT 32100 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Thoracotomy with cardiac massage CPT 32160 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Thorax spine fusion CPT 22610 | not published | not published | $7,609.00 – $33,471.73 | 6 |
| Thorax stereo rad targetw/tx CPT 32701 | not published | not published | $2,654.00 – $2,654.00 | 1 |
| Thorcscpy w/biop pleura CPT 32609 | not published | not published | $4,484.77 – $16,106.00 | 6 |
| Thor rib belt custom fabrica HCPCS L0220 | not published | not published | $119.07 – $306.41 | 4 |
| Thrcspy w/diag bp lng inf uni CPT 32607 | not published | not published | $5,257.00 – $20,292.15 | 6 |
| Thrcspy w/diag bp lng nod uni CPT 32608 | not published | not published | $5,257.00 – $20,292.15 | 6 |
| Throat x-ray & fluoroscopy CPT 70370 | not published | not published | $64.56 – $166.13 | 4 |
| Thrombectmy crnry perq mechanical CPT 92973 | $1,294.70 | $2,354.00 | $1,887.00 – $2,334.00 | 2 |
| Thrombectomy/inf pq dialysis circuit CPT 36904 | $4,672.25 | $8,495.00 | $4,222.18 – $18,364.00 | 6 |
| Thrombectomy/inf pq dialysis circuit w/pta CPT 36905 | $9,442.40 | $17,168.00 | $8,563.85 – $27,583.00 | 6 |
| Thrombectomy/inf pq dialysis circuit w/stent plcmnt CPT 36906 | $16,459.30 | $29,926.00 | $13,599.00 – $44,873.00 | 6 |
| Thromb/endar/neck inc/car/vert/subc35301 CPT 35301 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Thrombin time CPT 85670 | $49.50 | $90.00 | $4.33 – $11.14 | 7 |
| Thrombin time titer CPT 85675 | not published | not published | $5.14 – $13.22 | 7 |
| Thromboendarterectomy common femoral CPT 35371 | $2,717.00 | $4,940.00 | $3,735.00 – $3,735.00 | 1 |
| Thromboendarterectomy including patch graft if preformed; CPT 35321 | not published | not published | $4,127.91 – $18,364.00 | 6 |
| Thromboendarterectomy including patch graft; iliac 35351 CPT 35351 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Thromboendarterectomy sfa CPT 35302 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Thrombomodulin CPT 85337 | not published | not published | $12.95 – $33.33 | 7 |
| Thromboplastin inhibition CPT 85705 | not published | not published | $7.22 – $18.59 | 7 |
| Thromboplastin time partial (ptt) substitution fractions each CPT 85732 | $53.90 | $98.00 | $4.85 – $12.49 | 7 |
| Thromboxane urine CPT 84431 | not published | not published | $26.33 – $67.76 | 7 |
| Thumb fusion with graft CPT 26820 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Thumb fusion with graft CPT 26842 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Thumb tendon transfer CPT 26510 | not published | not published | $2,427.27 – $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.