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SSM Health St. Agnes Hospital - Fond du Lac

430 E Division St, Fond Du Lac, WI · SSM Health · · NPI 1346228541

Source: hospital's published price file ↗ · Published Apr 1, 2026 · Ingested Sep 10, 2026

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
Culture mycoplasma any source CPT 87109 $107.80 $196.00 $11.54 – $29.70 7
Culture quantitative aerobic other source CPT 87071 $100.65 $183.00 $7.42 – $19.09 7
Culture screening strep group a CPT 87081 $106.70 $194.00 $4.97 – $12.80 7
Culture typing added method CPT 87158 $89.10 $162.00 $5.80 – $14.94 7
Culture typing immunologic CPT 87147 $36.30 $66.00 $3.88 – $10.00 7
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets CPT 87154 $486.75 $885.00 $163.54 – $420.86 7
Culture typing nucleic acid probe amplified per culture/isolate each organism CPT 87150 not published not published $26.32 – $67.72 7
Culture urine each isolate CPT 87088 $60.50 $110.00 $6.07 – $15.61 7
Culture virus isolation CPT 87250 not published not published $14.67 – $37.75 7
Curette/treat cornea CPT 65435 not published not published $739.52 – $4,761.00 6
Curette/treat cornea CPT 65436 not published not published $1,763.69 – $7,791.00 6
Cutter lead HCPCS C1773 $1,021.81 $1,857.84 not published 0
Cv line/pic reposition CPT 36597 $3,012.35 $5,477.00 $1,167.76 – $3,030.00 6
Cyanocobalamin unsat binding capacity CPT 82608 $26.40 $48.00 $10.74 – $27.64 7
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution HCPCS J3420 not published not published $0.74 – $3.47 5
Cyclic citrullinated peptide antibody CPT 86200 $108.35 $197.00 $9.71 – $24.99 7
Cyclophosphamide 1 gram intravenous powder for solution HCPCS J9075 not published not published $0.43 – $2.39 8
Cyclophosphamide 25 mg capsule HCPCS J8530 not published not published $0.90 – $3.77 5
Cyclosporine 250 mg/5 ml intravenous solution HCPCS J7516 not published not published $77.26 – $194.27 5
Cyclosporine 2 hour CPT 80158 $135.85 $247.00 $13.54 – $34.84 7
Cyclosporine modified 25 mg capsule HCPCS J7515 not published not published $0.81 – $2.26 5
Cyclosporine oral 100 mg HCPCS J7502 not published not published $2.22 – $5.99 5
Cyp2c19 gene com variants CPT 81225 not published not published $218.52 – $562.32 7
Cyp2c9 gene com variants CPT 81227 not published not published $131.11 – $337.38 7
Cyp2d6 gene com variants CPT 81226 not published not published $338.18 – $870.26 7
Cyp3a4 gene common variants CPT 81230 not published not published $131.11 – $337.38 7
Cyp3a5 gene common variants CPT 81231 not published not published $131.11 – $337.38 7
Cystatin c CPT 82610 $60.50 $110.00 $13.89 – $35.74 7
Cystic fibrosis cftr CPT 81223 $1,327.70 $2,414.00 $374.25 – $963.07 7
Cystine urine quantitative CPT 82131 not published not published $17.24 – $44.35 7
Cysto cgen post urtl valves CPT 52400 not published not published $2,614.94 – $7,791.00 6
Cystogram >= 3 views supervision & interpretation CPT 74430 $471.90 $858.00 $70.80 – $665.99 4
Cysto impl 4 or more HCPCS C9740 not published not published $7,022.52 – $18,364.00 6
Cysto insj dev ischmc rmdlg CPT 53865 not published not published $3,735.00 – $18,071.30 4
Cysto, litho, vacuum kidney HCPCS C9761 not published not published $7,022.52 – $18,071.30 6
Cystometrogram w/up 51727 CPT 51727 not published not published $517.28 – $3,030.00 6
Cystorrhaphy wound comp 51865 CPT 51865 not published not published $3,735.00 – $8,770.00 3
Cystorrhaphy wound simple 51860 CPT 51860 not published not published $4,428.00 – $18,071.30 6
Cysto rx balo cath urtl strx CPT 52284 not published not published $3,977.55 – $10,235.57 5
Cystoscopy and biopsy CPT 52007 not published not published $2,614.94 – $7,791.00 6
Cystoscopy and radiotracer CPT 52250 not published not published $2,614.94 – $7,791.00 6
Cystoscopy and treatment CPT 52214 not published not published $2,614.94 – $7,791.00 6
Cystoscopy and treatment CPT 52224 not published not published $2,614.94 – $7,791.00 6
Cystoscopy and treatment CPT 52234 $1,076.46 $1,957.20 $2,614.94 – $7,791.00 6
Cystoscopy and treatment CPT 52235 not published not published $2,614.94 – $7,791.00 6
Cystoscopy and treatment CPT 52240 not published not published $3,977.55 – $10,235.57 6
Cystoscopy and treatment CPT 52260 not published not published $1,550.71 – $4,761.00 6
Cystoscopy and treatment CPT 52265 not published not published $1,550.71 – $3,990.50 6
Cystoscopy and treatment CPT 52276 not published not published $1,550.71 – $7,791.00 6
Cystoscopy and treatment CPT 52277 not published not published $2,614.94 – $7,791.00 6
Cystoscopy and treatment CPT 52283 not published not published $1,550.71 – $7,791.00 6
Cystoscopy and treatment CPT 52285 not published not published $517.28 – $4,761.00 6
Cystoscopy and treatment CPT 52290 not published not published $1,550.71 – $7,791.00 6
Cystoscopy and treatment CPT 52300 not published not published $2,614.94 – $7,791.00 6
Cystoscopy and treatment CPT 52301 not published not published $2,614.94 – $7,791.00 6
Cystoscopy and treatment CPT 52305 not published not published $3,977.55 – $10,235.57 6
Cystoscopy and treatment CPT 52310 $2,867.70 $5,214.00 $1,550.71 – $4,761.00 6
Cystoscopy and treatment CPT 52315 not published not published $1,550.71 – $7,791.00 6
Cystoscopy and treatment CPT 52320 not published not published $2,614.94 – $7,791.00 6
Cystoscopy and treatment CPT 52330 not published not published $2,614.94 – $7,791.00 6
Cystoscopy (Bladder Scope) CPT 52000 $851.40 $1,548.00 $517.28 – $3,030.00 6
Cystoscopy chemodenervation CPT 52287 $882.83 $1,605.15 $1,550.71 – $4,761.00 6
Cystoscopy & duct catheter CPT 52010 not published not published $517.28 – $3,030.00 6
Cystoscopy implant stent CPT 52282 not published not published $2,614.94 – $7,791.00 6
Cystoscopy inject material CPT 52327 not published not published $3,977.55 – $16,106.00 6
Cystoscopy prostatic imp 1-3 HCPCS C9739 not published not published $3,977.55 – $10,235.57 6
Cystoscopy removal of clots CPT 52001 $856.68 $1,557.60 $2,614.94 – $6,729.12 6
Cystoscopy & revise urethra CPT 52270 not published not published $1,550.71 – $4,761.00 6
Cystoscopy & revise urethra CPT 52275 not published not published $1,550.71 – $7,791.00 6
Cystoscopy stone removal CPT 52325 not published not published $3,977.55 – $10,235.57 6
Cystoscopy & ureter catheter CPT 52005 $2,695.55 $4,901.00 $1,550.71 – $7,791.00 6
Cystostomy cystotomy w/drainage 51040 CPT 51040 not published not published $1,550.71 – $7,791.00 6
Cystotomy/cystostomy fulg+/insj radact matrl 51020 CPT 51020 not published not published $2,614.94 – $7,791.00 6
Cystotomy excise/incise/repair 51535 CPT 51535 not published not published $2,614.94 – $7,791.00 6
Cystouretero & or pyeloscope CPT 52351 $1,306.14 $2,374.80 $2,614.94 – $7,791.00 6
Cysto/uretero stricture tx CPT 52344 not published not published $2,614.94 – $7,791.00 6
Cystouretero w/biopsy CPT 52354 not published not published $3,977.55 – $10,235.57 6
Cystouretero w/excise tumor CPT 52355 not published not published $3,977.55 – $10,235.57 6
Cysto/uretero w/lithotripsy CPT 52356 $2,807.97 $5,105.40 $3,977.55 – $16,106.00 6
Cystouretero w/lithotripsy CPT 52353 not published not published $3,977.55 – $16,106.00 6
Cystouretero w/renal strict CPT 52346 not published not published $3,977.55 – $10,235.57 6
Cystouretero w/stone remove CPT 52352 not published not published $2,614.94 – $7,791.00 6
Cysto/uretero w/up stricture CPT 52345 not published not published $2,614.94 – $7,791.00 6
Cystourethro cut ejacul duct CPT 52402 not published not published $2,614.94 – $7,791.00 6
Cystourethroscop/calib/dilat stric 52281 CPT 52281 $2,727.45 $4,959.00 $1,550.71 – $4,761.00 6
Cystourethroscopy w/biopsy(s) 52204 CPT 52204 not published not published $1,550.71 – $7,791.00 6
Cystourethro w/addl implant 52442 CPT 52442 not published not published $1,887.00 – $3,735.00 3
Cystourethro w/implant CPT 52441 not published not published $1,887.00 – $3,735.00 3
Cysto w/renal stricture tx CPT 52343 not published not published $2,614.94 – $7,791.00 6
Cysto w/up stricture tx CPT 52342 not published not published $2,614.94 – $7,791.00 6
Cysto w/ureter stricture tx CPT 52341 not published not published $2,614.94 – $7,791.00 6
Cytarabine 20 mg/ml injection solution HCPCS J9100 not published not published $0.86 – $2.15 5
Cytogenetics 25-99 CPT 88274 not published not published $31.78 – $81.79 7
Cytogenetics 3-5 CPT 88272 not published not published $30.52 – $78.55 7
Cytogenomic neo microra alys CPT 81277 not published not published $870.00 – $2,238.80 7
Cytogenom microarray copy nmbr var CPT 81228 not published not published $675.00 – $1,737.00 7
Cytomegalovirus (cmv) antibody igg CPT 86644 $83.60 $152.00 $10.79 – $27.77 7
Cytomegalovirus (cmv) antibody igm CPT 86645 $695.75 $1,265.00 $11.77 – $32.52 7
Cytomegalovirus dfa CPT 87271 not published not published $10.06 – $25.90 7
Cytomegalovirus imm IV /vial HCPCS J0850 not published not published $1,394.12 – $4,938.91 8

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.