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 |
|---|---|---|---|---|
| Th/wght bear nar m-l brim cu HCPCS L2526 | not published | not published | $590.32 – $1,519.08 | 4 |
| Th/wght bear nar m-l brim mo HCPCS L2525 | not published | not published | $1,050.58 – $2,703.49 | 4 |
| Th/wght bear quad-lat brim c HCPCS L2520 | not published | not published | $495.44 – $1,274.92 | 4 |
| Th/wght bear quad-lat brim m HCPCS L2510 | not published | not published | $743.39 – $1,913.00 | 4 |
| Thymectomy prtl/tot rad medstnl dsj 60522 CPT 60522 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Thymectomy prtl/tot transcervical appr 60520 CPT 60520 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Thymectomy prtl/tot without rad medstnl dsj 60521 CPT 60521 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Thyroglobulin antibody CPT 86800 | $138.60 | $252.00 | $11.93 – $30.71 | 7 |
| Thyroidectomy inc substrnl split/trans approch 60270 CPT 60270 | not published | not published | $3,579.00 – $4,761.00 | 3 |
| Thyroid imaging CPT 78013 | $1,936.00 | $3,520.00 | $296.56 – $763.16 | 4 |
| Thyroid met imaging CPT 78015 | not published | not published | $296.56 – $763.16 | 4 |
| Thyroid met imaging/studies CPT 78016 | not published | not published | $296.56 – $763.16 | 4 |
| Thyroid mets imag whole body CPT 78018 | $1,936.00 | $3,520.00 | $402.79 – $1,036.52 | 4 |
| Thyroid met uptake CPT 78020 | not published | not published | $192.71 – $192.71 | 1 |
| Thyroid (TSH) Test CPT 84443 | $138.60 | $252.00 | $12.60 – $32.42 | 7 |
| Thyroid Ultrasound CPT 76536 | $409.20 | $744.00 | $77.56 – $199.58 | 4 |
| Thyroid uptake measurement CPT 78012 | not published | not published | $240.22 – $763.16 | 4 |
| Thyrotropin alfa 0.9 mg intramuscular solution HCPCS J3240 | not published | not published | $1,619.00 – $5,629.88 | 8 |
| Thyrotropin releasing hormone CPT 80438 | not published | not published | $37.81 – $97.29 | 7 |
| Thyroxine binding globulin (tbg) CPT 84442 | not published | not published | $11.08 – $28.53 | 7 |
| Tibial arthroscopy/surgery CPT 29855 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Tibial arthroscopy/surgery CPT 29856 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Tibial length sock fx or equ HCPCS L2840 | not published | not published | $39.76 – $102.33 | 4 |
| Tibial tubercle hgt with toe f HCPCS L5020 | not published | not published | $2,316.90 – $5,962.16 | 4 |
| Tib/per revasc stent & ather 37231 CPT 37231 | $16,951.00 | $30,820.00 | $8,923.00 – $44,873.00 | 3 |
| Tib/per revasc stnt & ather CPT 37235 | not published | not published | $5,512.00 – $18,364.00 | 3 |
| Tib/per revasc w/ather add-on 37233 CPT 37233 | not published | not published | $5,512.00 – $27,583.00 | 3 |
| Tigecycline injection HCPCS J3243 | not published | not published | $0.33 – $1.72 | 5 |
| Tilt table locking hip sing HCPCS L5270 | not published | not published | $5,753.26 – $14,805.05 | 4 |
| Tilt table study CPT 93660 | $1,786.40 | $3,248.00 | $276.82 – $2,334.00 | 6 |
| Tinzaparin sodium injection HCPCS J1655 | not published | not published | $9.69 – $9.69 | 1 |
| Tirofiban 12.5 mg/50 ml HCPCS J3246 | not published | not published | $3.91 – $9.85 | 5 |
| Tisagenlecleucel car-pos t HCPCS Q2042 | not published | not published | $458,769.88 – $1,539,910.91 | 7 |
| Tis clt agrft f/s/n/h/f/g ad CPT 15156 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Tis clt agrft f/s/n/h/f/g ea CPT 15157 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Tis cltr skn agrft t/a/l add CPT 15151 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Tis cltr skn agrft t/a/l ea CPT 15152 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Tisotumab vedotin-tftv 40 mg intravenous solution HCPCS J9273 | not published | not published | $147.09 – $495.15 | 8 |
| Tiss ex molecul study add-on CPT 88388 | not published | not published | $14.03 – $14.03 | 1 |
| Tissue amnio epifix inj 100mg HCPCS Q4145 | not published | not published | $37.01 – $37.01 | 1 |
| Tissue culture placenta CPT 88235 | not published | not published | $100.79 – $290.08 | 7 |
| Tissue culture skin/biopsy CPT 88233 | $40.70 | $74.00 | $100.79 – $271.61 | 7 |
| Tissue culture tumor CPT 88239 | not published | not published | $100.79 – $284.71 | 7 |
| Tissue exam koh skin/hair/nails CPT 87220 | $41.80 | $76.00 | $3.20 – $8.24 | 7 |
| Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm HCPCS Q4122 | not published | not published | $92.32 – $329.51 | 5 |
| Tissue transglutaminase iga CPT 86364 | $64.35 | $117.00 | $8.65 – $22.25 | 7 |
| Tl-201 thallium diag per mci HCPCS A9505 | $41.25 | $75.00 | $117.12 – $117.12 | 1 |
| Tlh uterus 250 g or less CPT 58570 | not published | not published | $7,609.00 – $20,292.15 | 6 |
| Tlh uterus over 250 g CPT 58572 | not published | not published | $7,609.00 – $20,292.15 | 6 |
| Tlh w/t/o 250 g or less CPT 58571 | not published | not published | $7,609.00 – $20,292.15 | 6 |
| Tlh w/t/o uterus over 250 g CPT 58573 | not published | not published | $7,609.00 – $20,292.15 | 6 |
| Tlso 2mod symphis-xipho pre HCPCS L0458 | not published | not published | $822.04 – $2,115.40 | 4 |
| Tlso 2 piece rigid shell HCPCS L0491 | not published | not published | $707.88 – $1,821.61 | 4 |
| Tlso 2 shl symphys-stern cst HCPCS L0460 | not published | not published | $925.26 – $2,381.00 | 4 |
| Tlso 3mod sacro-scap pre HCPCS L0462 | not published | not published | $1,150.85 – $2,961.53 | 4 |
| Tlso 3 piece rigid shell HCPCS L0492 | not published | not published | $460.94 – $1,186.16 | 4 |
| Tlso corset front HCPCS L0970 | not published | not published | $98.50 – $253.49 | 4 |
| Tlso flex trnk sj-t9 pre ots HCPCS L0455 | not published | not published | $171.50 – $441.31 | 4 |
| Tlso full corset HCPCS L0974 | not published | not published | $161.07 – $414.49 | 4 |
| Tlso r fram soft ant pre cst HCPCS L0466 | not published | not published | $349.70 – $899.88 | 4 |
| Tlso r fram soft pre ots HCPCS L0467 | not published | not published | $192.34 – $494.95 | 4 |
| Tlso rig fram pelvic pre cst HCPCS L0468 | not published | not published | $438.26 – $1,127.78 | 4 |
| Tlso rig fram pelvic pre ots HCPCS L0469 | not published | not published | $245.07 – $630.65 | 4 |
| Tlso rigid frame pre subclav HCPCS L0470 | not published | not published | $606.44 – $1,560.58 | 4 |
| Tlso rigid lined custom fab HCPCS L0482 | not published | not published | $1,555.12 – $4,001.84 | 4 |
| Tlso rigid lined pre one pie HCPCS L0488 | not published | not published | $925.26 – $2,381.00 | 4 |
| Tlso rigid plastic cust fab HCPCS L0484 | not published | not published | $1,679.45 – $4,321.79 | 4 |
| Tlso rigid plastic custom fa HCPCS L0480 | not published | not published | $1,392.22 – $3,582.64 | 4 |
| Tlso rigid plastic pre one HCPCS L0490 | not published | not published | $260.73 – $670.95 | 4 |
| Tlso trnk sj-t9 pre cst HCPCS L0454 | not published | not published | $319.66 – $822.60 | 4 |
| Tmvr w/prosthetic ring 33426 CPT 33426 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Tmvr w/rad reconst w or without ring 33427 CPT 33427 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Tnot opn elbw to sho ea tdn CPT 24310 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Tobramycin comp unit HCPCS J7685 | not published | not published | $157.64 – $157.64 | 1 |
| Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr HCPCS J3260 | not published | not published | $1.76 – $5.36 | 5 |
| Tobramycin non-comp unit HCPCS J7682 | not published | not published | $16.28 – $43.56 | 5 |
| Tobramycin peak therapeutic drug level CPT 80200 | $139.15 | $253.00 | $12.10 – $31.13 | 7 |
| Tocilizumab 162 mg/0.9 ml subcutaneous pen injector HCPCS J3262 | not published | not published | $4.06 – $16.25 | 8 |
| Tocilizumab for covid-19 HCPCS Q0249 | not published | not published | $8.33 – $20.61 | 4 |
| Toe joint transfer CPT 26556 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Tomosynthesis breast diagnostic left HCPCS G0279 | not published | not published | $9.12 – $23.47 | 4 |
| Tomosynthesis breast screen bilateral CPT 77063 | $19.25 | $35.00 | $16.80 – $43.23 | 4 |
| Tone decay hearing test CPT 92563 | not published | not published | $27.71 – $71.30 | 4 |
| Tongue and neck surgery CPT 41135 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Tongue base vol reduction CPT 41530 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Tongue biopsy; posterior one-third 41105 CPT 41105 | not published | not published | $2,459.51 – $6,329.15 | 6 |
| Tongue jaw & neck surgery CPT 41155 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Tongue mouth jaw surgery CPT 41150 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Tongue mouth neck surgery CPT 41153 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Tongue removal neck surgery CPT 41145 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Tongue suspension CPT 41512 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Tongue to lip surgery CPT 41510 | not published | not published | $2,459.51 – $6,329.15 | 6 |
| Tonsillectomy (age 12+) CPT 42826 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Tonsillectomy (child under 12) CPT 42825 | not published | not published | $4,391.52 – $11,300.84 | 6 |
| Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution HCPCS J9351 | not published | not published | $1.40 – $4.85 | 5 |
| Topotecan oral HCPCS J8705 | not published | not published | $94.00 – $340.11 | 8 |
| Toripalimab-tpzi 240 mg/6 ml (40 mg/ml) intravenous solution HCPCS J3263 | not published | not published | $30.67 – $107.05 | 8 |
| Torsion ank & half solid sti HCPCS L2375 | not published | not published | $113.42 – $291.85 | 4 |
| Torsion straight knee joint HCPCS L2380 | not published | not published | $118.95 – $306.10 | 4 |
| Tot abd hyst/par vag/pelv node sam 58200 CPT 58200 | not published | not published | $5,257.00 – $5,257.00 | 1 |
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.