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 |
|---|---|---|---|---|
| Triamcinolone acetonide 40 mg/ml suspension for injection HCPCS J3301 | not published | not published | $0.96 – $2.46 | 5 |
| Triamcinolone a inj prs-free HCPCS J3300 | not published | not published | $14.39 – $77.10 | 6 |
| Triamcinolone diacetate inj HCPCS J3302 | not published | not published | $0.87 – $0.87 | 1 |
| Triamcinolone hexacetonl inj HCPCS J3303 | not published | not published | $26.55 – $26.55 | 1 |
| Trichinella antibody CPT 86784 | not published | not published | $9.42 – $24.24 | 7 |
| Trichomonas assay w/optic CPT 87808 | not published | not published | $11.47 – $29.51 | 7 |
| Triglycerides CPT 84478 | $50.05 | $91.00 | $4.30 – $11.08 | 7 |
| Trilaciclib 300 mg intravenous solution HCPCS J1448 | not published | not published | $4.10 – $14.62 | 8 |
| Trimethobenzamide hci 250mg HCPCS Q0173 | not published | not published | $1.77 – $1.77 | 1 |
| Trimethobenzamide hcl inj HCPCS J3250 | not published | not published | $55.04 – $138.72 | 5 |
| Trim nail(s) HCPCS G0127 | $55.55 | $101.00 | $43.76 – $2,334.00 | 6 |
| Trim nondyst nails CPT 11719 | $62.70 | $114.00 | $43.76 – $2,334.00 | 6 |
| Triptorelin pamoate HCPCS J3315 | not published | not published | $349.77 – $1,310.31 | 8 |
| Trluml dil aq o/f can without st CPT 66174 | not published | not published | $3,066.31 – $16,106.00 | 6 |
| Trluml dil aq o/f can w/st CPT 66175 | not published | not published | $3,947.51 – $16,106.00 | 6 |
| Trml dstrj ios bvn 1st 2 l/s CPT 64628 | not published | not published | $7,609.00 – $24,508.80 | 6 |
| Trml dstrj ios bvn ea addl CPT 64629 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Trmt of fracture (femoral shaft) 27500 CPT 27500 | not published | not published | $182.99 – $2,334.00 | 6 |
| Trnscath plc stent crv crtd without prtct CPT 37216 | $7,239.10 | $13,162.00 | $6,779.00 – $6,779.00 | 1 |
| Trnscath plc stent crv crtd w/prtct CPT 37215 | $7,309.50 | $13,290.00 | $3,735.00 – $3,735.00 | 1 |
| Trnscath plc stnt ante carotid art CPT 37218 | $7,225.90 | $13,138.00 | $3,735.00 – $3,735.00 | 1 |
| Trnscath plc vas stent w/s&i ea addl artery CPT 37237 | $7,582.85 | $13,787.00 | $5,512.00 – $18,364.00 | 3 |
| Trnscath plc vas stent w/s&i ea addl vein CPT 37239 | $6,624.75 | $12,045.00 | $5,512.00 – $18,364.00 | 3 |
| Trnscath plc vas stent w/s&i ini vein CPT 37238 | $13,202.20 | $24,004.00 | $7,609.00 – $27,583.00 | 6 |
| Trnscath retrv pq vasc fb w/guide CPT 37197 | $3,625.05 | $6,591.00 | $2,342.32 – $8,770.00 | 6 |
| Trnscath tx thromblytc artery non-intracrn ini day CPT 37211 | $2,889.15 | $5,253.00 | $4,127.91 – $18,364.00 | 6 |
| Trnscath tx thromblytc art/ven sbsq day CPT 37213 | $3,322.00 | $6,040.00 | $2,342.32 – $6,027.57 | 6 |
| Trnscath tx thromblytc cath rmv sbsq day CPT 37214 | $2,776.95 | $5,049.00 | $2,342.32 – $6,027.57 | 6 |
| Trnscath tx thromblytc vein ini day CPT 37212 | $1,725.35 | $3,137.00 | $2,342.32 – $8,770.00 | 6 |
| Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm CPT 14301 | not published | not published | $2,628.85 – $8,770.00 | 6 |
| Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/< CPT 14302 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/< CPT 14060 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm CPT 14061 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm CPT 14021 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm CPT 14001 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/< CPT 14000 | not published | not published | $1,530.61 – $4,761.00 | 6 |
| Trnsplj pd lvr&bwl cd154+cll CPT 81560 | not published | not published | $480.55 – $1,236.61 | 7 |
| Trnspl rej kdn mrna qpcr 139 CPT 81558 | not published | not published | $2,430.00 – $6,253.20 | 7 |
| Trnsxj/repos abrrnt rnl vsls CPT 50100 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Troponin quantitative CPT 84484 | $87.45 | $159.00 | $9.35 – $24.07 | 7 |
| Tr retinal les preterm inf CPT 67229 | not published | not published | $408.01 – $3,030.00 | 6 |
| Trurl dstrj prst8 tiss rf wv CPT 53854 | not published | not published | $2,614.94 – $7,791.00 | 6 |
| Truskin, per sq centimeter HCPCS Q4167 | not published | not published | $92.32 – $329.47 | 5 |
| Truss addition to std pad wa HCPCS L8320 | not published | not published | $56.92 – $146.49 | 4 |
| Truss add to std pad scrotal HCPCS L8330 | not published | not published | $45.33 – $116.65 | 4 |
| Truss double with standard pad HCPCS L8310 | not published | not published | $137.21 – $353.09 | 4 |
| Truss single with standard pad HCPCS L8300 | not published | not published | $77.46 – $199.33 | 4 |
| Tte w or without contr, cont ecg HCPCS C8930 | not published | not published | $581.54 – $1,496.49 | 4 |
| Tte w or without fol w/con,stres HCPCS C8928 | $884.40 | $1,608.00 | $581.54 – $1,496.49 | 4 |
| Tte w or without fol w/cont, com HCPCS C8921 | $1,199.00 | $2,180.00 | $581.54 – $1,496.49 | 4 |
| Tte w or without fol w/cont, f/u HCPCS C8922 | not published | not published | $581.54 – $1,496.49 | 4 |
| Tubal Ligation (Laparoscopic) CPT 58670 | not published | not published | $4,484.77 – $18,364.00 | 6 |
| Tube trach disp innr can 6 xlt HCPCS A4623 | $139.88 | $254.32 | not published | 0 |
| Tube trach fen sz 6 uncuffed HCPCS A7520 | $169.85 | $308.82 | not published | 0 |
| Tumor cell deplete of harvst CPT 38211 | not published | not published | $327.28 – $2,334.00 | 6 |
| Tvh >250 gms 58290 CPT 58290 | not published | not published | $5,501.01 – $16,106.00 | 6 |
| Tvh w/mmk 58267 CPT 58267 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Twelve volt battery utah/equ HCPCS L7364 | not published | not published | $472.27 – $1,215.30 | 4 |
| Tx atrial fib pulm vein isol CPT 93656 | $25,527.15 | $46,413.00 | $19,389.90 – $49,896.68 | 6 |
| Tx closed distal humerus fx CPT 24999 | $398.20 | $724.00 | $182.99 – $2,334.00 | 6 |
| Tx closed hip disl traumatic without anes CPT 27250 | $1,508.65 | $2,743.00 | $182.99 – $2,334.00 | 6 |
| Tx closed tib fx proximal w/w/o manip w/skel trac CPT 27532 | not published | not published | $2,427.27 – $6,246.19 | 6 |
| Tx closed tib shaft fx without manip CPT 27750 | not published | not published | $182.99 – $2,334.00 | 6 |
| Tx contour defects >10.0 cc CPT 11954 | not published | not published | $548.27 – $3,030.00 | 6 |
| Tx contour defects 1.1-5.0cc 11951 CPT 11951 | not published | not published | $548.27 – $2,334.00 | 6 |
| Tx ectopic pregnancy abdl pregnancy 59130 CPT 59130 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Tx ectopic pregnancy ntrstl prtl rescj uter 59136 CPT 59136 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Tx l/r atrial fib addl CPT 93657 | $8,279.15 | $15,053.00 | $1,887.00 – $2,334.00 | 2 |
| Tx open art fx mcp/iphlngl jnt incl int fixtn ea CPT 26746 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Tx open dstl phlngl fx f/t internal fixation ea CPT 26765 | $2,857.25 | $5,195.00 | $2,427.27 – $7,791.00 | 6 |
| Tx open iphlngl jt disl internal fixation sngl CPT 26785 | $6,797.45 | $12,359.00 | $2,427.27 – $7,791.00 | 6 |
| Tx open nsl fx uncomp CPT 21325 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Tx open nsl sptl fx CPT 21336 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Tx phalangeal shaft fx open prox/middle ea CPT 26735 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Tx septic abortion surgical 59830 CPT 59830 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Tx tarsal bone fx without manip 28450 CPT 28450 | not published | not published | $182.99 – $2,334.00 | 6 |
| Tympanic membrane repair CPT 69610 | not published | not published | $1,151.01 – $7,791.00 | 6 |
| Tympanolysis transcanal 69450 CPT 69450 | not published | not published | $2,459.51 – $16,106.00 | 6 |
| Tympanometry & reflex thresh CPT 92550 | not published | not published | $160.18 – $412.19 | 4 |
| Tympanostomy/ven tube/loc/top anes 69433 CPT 69433 | not published | not published | $400.09 – $2,334.00 | 6 |
| Tympp antrt/mastoidotomy prosthesis torp 69637 CPT 69637 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Tympp antrt/mastoid without ossic chain recnst 69635 CPT 69635 | not published | not published | $4,391.52 – $16,106.00 | 6 |
| Tyms gene com variants CPT 81346 | not published | not published | $131.11 – $337.38 | 7 |
| Typhoid vaccine oral CPT 90690 | not published | not published | $245.70 – $245.70 | 1 |
| U2af1 gene common variants CPT 81357 | not published | not published | $144.94 – $372.97 | 7 |
| Ua w/micro/comp poc CPT 81000 | not published | not published | $3.02 – $7.76 | 7 |
| Ublituximab-xiiy 25 mg/ml intravenous solution HCPCS J2329 | not published | not published | $54.18 – $187.94 | 8 |
| Ue triple control harness HCPCS L6677 | not published | not published | $273.94 – $704.95 | 4 |
| Ugt1a1 gene analy common variants CPT 81350 | not published | not published | $175.50 – $451.62 | 7 |
| Ultrasound abdomen aorta screening study aaa CPT 76706 | $409.20 | $744.00 | $77.56 – $199.58 | 4 |
| Ultrasound bone density measure CPT 76977 | not published | not published | $13.78 – $199.58 | 4 |
| Ultrasound breast complete CPT 76641 | $436.70 | $794.00 | $77.56 – $199.58 | 4 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $449.35 | $817.00 | $64.56 – $166.13 | 4 |
| Ultrasound chest CPT 76604 | $470.80 | $856.00 | $77.56 – $199.58 | 4 |
| Ultrasound doppler velocimetry fetal umbilical artery CPT 76820 | $485.10 | $882.00 | $73.17 – $199.58 | 4 |
| Ultrasound dx ophth b-scan CPT 76512 | $424.05 | $771.00 | $77.56 – $199.58 | 4 |
| Ultrasound elastography ea l target les CPT 76983 | $52.25 | $95.00 | $114.24 – $114.24 | 1 |
| Ultrasound elastography parenchyma CPT 76981 | $207.35 | $377.00 | $77.56 – $199.58 | 4 |
| Ultrasound encephalogram CPT 76506 | $409.20 | $744.00 | $77.56 – $199.58 | 4 |
| Ultrasound exam k transpl w/doppler CPT 76776 | $409.20 | $744.00 | $77.56 – $199.58 | 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.