SSM Health Waupun Memorial Hospital
620 W Brown St, Waupun, WI · SSM Health · · NPI 1548248644
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 |
|---|---|---|---|---|
| Change nephroureteral cath CPT 50387 | $4,298.25 | $7,815.00 | $3,388.00 – $4,761.00 | 3 |
| Change of ureter tube/stent CPT 50688 | $1,591.70 | $2,894.00 | $3,388.00 – $4,761.00 | 3 |
| Change of windpipe airway 31502 CPT 31502 | $319.00 | $580.00 | $1,887.00 – $2,654.00 | 3 |
| Change stent via transureth CPT 50385 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Change ureter stent percut CPT 50382 | $2,682.90 | $4,878.00 | $3,388.00 – $7,791.00 | 3 |
| Chct for mal hyperthermia CPT 89049 | not published | not published | $96.64 – $143.50 | 2 |
| Chemical exfoliation acne 17360 CPT 17360 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Chemical peel face epiderm 15788 CPT 15788 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Chemical peel nonfacial 15793 CPT 15793 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Chemical peel nonfacial; epidermal CPT 15792 | not published | not published | $2,654.00 – $3,030.00 | 3 |
| Chemo adm cns w/lmbr punct CPT 96450 | $393.80 | $716.00 | not published | 0 |
| Chemodener muscle larynx emg CPT 64617 | not published | not published | $1,887.00 – $3,030.00 | 3 |
| Chemodenerv 1 extrem 1-4 ea 64643 CPT 64643 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Chemodenerv 1 extrem 5/> ea 64645 CPT 64645 | $1,451.45 | $2,639.00 | $1,887.00 – $5,512.00 | 3 |
| Chemodenerv 1 extrem 5/> mus 64644 CPT 64644 | not published | not published | $2,654.00 – $3,030.00 | 3 |
| Chemodenerv 1 extremity 1-4 64642 CPT 64642 | $1,088.45 | $1,979.00 | $2,654.00 – $3,030.00 | 3 |
| Chemodenervation anal musc CPT 46505 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Chemodenervation/face muscl/unilat 64612 CPT 64612 | $805.75 | $1,465.00 | $1,887.00 – $2,654.00 | 3 |
| Chemodenervation nerve of eye muscle 67345 CPT 67345 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Chemodenerv eccrine glands CPT 64653 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Chemodenerv eccrine glands 64650 CPT 64650 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Chemodenerv musc migraine 64615 CPT 64615 | $832.15 | $1,513.00 | $1,887.00 – $2,654.00 | 3 |
| Chemodenerv musc neck dyston 64616 CPT 64616 | $1,915.65 | $3,483.00 | $1,887.00 – $2,654.00 | 3 |
| Chemodenerv saliv glands bilat 64611 CPT 64611 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Chemodenerv trunk musc 1-5 64646 CPT 64646 | $1,088.45 | $1,979.00 | $2,654.00 – $3,030.00 | 3 |
| Chemodenerv trunk musc 6/] 64647 CPT 64647 | $1,377.75 | $2,505.00 | $2,654.00 – $3,030.00 | 3 |
| Chemo extend IV infus w/pump HCPCS G0498 | $382.25 | $695.00 | not published | 0 |
| Chemo ia infusion up to 1 hr CPT 96422 | $212.30 | $386.00 | not published | 0 |
| Chemo ia push tecnique CPT 96420 | $611.60 | $1,112.00 | not published | 0 |
| Chemotaxis assay CPT 86155 | not published | not published | $15.99 – $32.35 | 4 |
| Chemotherapy injection 96542 CPT 96542 | $388.85 | $707.00 | not published | 0 |
| Chest 2 vws w oblique CPT 71048 | $261.25 | $475.00 | $84.99 – $84.99 | 1 |
| Chest apical lordotic proj CPT 71047 | $261.25 | $475.00 | $82.60 – $82.60 | 1 |
| Chest CT scan (with and without contrast) CPT 71270 | $1,714.35 | $3,117.00 | $682.72 – $682.72 | 1 |
| Chest CT scan (with contrast) CPT 71260 | $1,632.95 | $2,969.00 | $553.21 – $553.21 | 1 |
| Chest CT scan (without contrast) CPT 71250 | $1,554.85 | $2,827.00 | $427.26 – $427.26 | 1 |
| Chest X-ray CPT 71046 | $261.25 | $475.00 | $64.74 – $64.74 | 1 |
| Chest X-ray (single view) CPT 71045 | $261.25 | $475.00 | $34.96 – $34.96 | 1 |
| Chg pr pul rehab for copd patients CPT 94626 | $147.95 | $269.00 | not published | 0 |
| Chg radiologic exam esophagus double contrast CPT 74221 | $276.65 | $503.00 | $240.66 – $240.66 | 1 |
| Chimerism anal no cell selec CPT 81267 | not published | not published | $207.46 – $419.78 | 4 |
| Chimerism anal w/cell select CPT 81268 | not published | not published | $260.79 – $527.70 | 4 |
| Chlamydia culture CPT 87110 | not published | not published | $19.60 – $39.65 | 4 |
| Chlamydia trachomatis ag if CPT 87270 | not published | not published | $11.98 – $24.26 | 4 |
| Chlamydia type CPT 87140 | $36.30 | $66.00 | $5.57 – $9.75 | 4 |
| Chlnggrphy intraop addl s&i CPT 74301 | not published | not published | $65.08 – $65.08 | 1 |
| Chloramphenicol sodium injec HCPCS J0720 | not published | not published | $158.94 – $158.94 | 1 |
| Chloride CPT 82435 | $38.50 | $70.00 | $4.60 – $9.31 | 4 |
| Chloride 24 hour urine CPT 82436 | $46.75 | $85.00 | $5.75 – $10.18 | 4 |
| Chloroprocaine hcl injection HCPCS J2401 | not published | not published | $0.04 – $0.08 | 5 |
| Chloroprocaine opht gel, 1mg HCPCS J2403 | not published | not published | $0.66 – $1.67 | 5 |
| Chlorothiazide sodium 500 mg intravenous solution HCPCS J1205 | not published | not published | $35.73 – $164.60 | 5 |
| Chlorpromazine 0.125 mg/ml IV syringe - cnr HCPCS J3230 | not published | not published | $31.94 – $82.98 | 5 |
| Cholangiogram percutaneous compl CPT 47532 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Cholangiography and/or pancreatography intraoperative supervision & interpretation CPT 74300 | $276.65 | $503.00 | $112.83 – $112.83 | 1 |
| Cholecystectomy expl duct 47612 CPT 47612 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Cholecystectomy w/cholangiography 47605 CPT 47605 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Cholecystoenterostomy direct 47720 CPT 47720 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Cholecystostomy complete w/supervision & interpretation CPT 47490 | $2,391.95 | $4,349.00 | $3,735.00 – $8,770.00 | 3 |
| Cholesterol CPT 82465 | $44.55 | $81.00 | $4.35 – $8.80 | 4 |
| Cholesterol body fluid CPT 84999 | $132.55 | $241.00 | not published | 0 |
| Cholesterol (Lipid) Test CPT 80061 | $118.80 | $216.00 | $13.39 – $27.10 | 4 |
| Choline c-11 HCPCS A9515 | not published | not published | $5,616.35 – $5,616.35 | 1 |
| Cholinesterase CPT 82480 | not published | not published | $7.87 – $15.94 | 4 |
| Chorion biopsy CPT 59015 | $1,525.70 | $2,774.00 | $2,654.00 – $3,030.00 | 3 |
| Chorionic gonadotropin/1000u HCPCS J0725 | not published | not published | $20.08 – $53.56 | 5 |
| Chrom analysis CPT 88273 | not published | not published | $34.81 – $65.02 | 4 |
| Chromatogram assay sugars CPT 84375 | not published | not published | $11.77 – $68.25 | 4 |
| Chromatography CPT 83021 | $156.75 | $285.00 | $18.06 – $36.53 | 4 |
| Chromogenic substrate assay CPT 85130 | not published | not published | $11.89 – $24.07 | 4 |
| Chromo high res and frag x - sendout CPT 81243 | not published | not published | $57.04 – $99.82 | 4 |
| Chromosome analys amniotic CPT 88269 | not published | not published | $173.66 – $336.56 | 4 |
| Chromosome analysis 100 CPT 88249 | not published | not published | $173.17 – $350.42 | 4 |
| Chromosome analysis 15-20 cell count CPT 88262 | $770.00 | $1,400.00 | $125.49 – $252.20 | 4 |
| Chromosome analysis 20-25 CPT 88245 | not published | not published | $173.17 – $303.05 | 4 |
| Chromosome analysis 45 CPT 88263 | not published | not published | $150.29 – $304.12 | 4 |
| Chromosome analysis 5 CPT 88261 | not published | not published | $264.34 – $462.60 | 4 |
| Chromosome analysis 50-100 CPT 88248 | not published | not published | $173.17 – $350.42 | 4 |
| Chromosome analys placenta CPT 88267 | not published | not published | $188.57 – $363.78 | 4 |
| Chromosome banding study CPT 88283 | not published | not published | $68.60 – $138.83 | 4 |
| Chromosome count additional CPT 88285 | not published | not published | $26.91 – $47.09 | 4 |
| Chromosome karyotype study CPT 88280 | $55.00 | $100.00 | $33.47 – $58.57 | 4 |
| Chromosome study additional CPT 88289 | not published | not published | $34.43 – $69.68 | 4 |
| Chronic urticaria - sendout CPT 86343 | not published | not published | $12.46 – $25.22 | 4 |
| Chylomicron screen, bf - sendout CPT 82664 | $111.10 | $202.00 | $61.50 – $107.63 | 4 |
| Cidofovir injection HCPCS J0740 | not published | not published | $326.01 – $1,005.81 | 5 |
| Cilastatin sodium injection HCPCS J0743 | not published | not published | $7.80 – $19.60 | 5 |
| Ciliary transsleral therapy CPT 66710 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Ciltacabtagene car-pos t HCPCS Q2056 | not published | not published | $608,486.23 – $1,500,964.18 | 4 |
| Cinacalcet 30 mg tablet HCPCS J0604 | not published | not published | $2.69 – $2.69 | 1 |
| Cine/video x-rays CPT 76120 | not published | not published | $213.40 – $213.40 | 1 |
| Cine/video x-rays add-on CPT 76125 | not published | not published | $105.72 – $105.72 | 1 |
| Ciprofloxacin 400 mg/200 ml in 5 % dextrose intravenous piggyback HCPCS J0744 | not published | not published | $0.89 – $4.41 | 5 |
| Ciprofloxacin otic susp 6 mg HCPCS J7342 | not published | not published | $92.52 – $92.52 | 1 |
| Circum 28 days or older CPT 54161 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Circumcise/surg/28 days or < 54160 CPT 54160 | not published | not published | $2,654.00 – $7,791.00 | 3 |
| Circumcision (newborn) CPT 54150 | $94.60 | $172.00 | $3,388.00 – $7,791.00 | 3 |
| Cisplatin 1 mg/ml desensitization HCPCS J9060 | not published | not published | $2.91 – $7.33 | 5 |
| C-kit mutation liquid tumor - sendout CPT 81272 | $783.20 | $1,424.00 | $329.51 – $576.64 | 4 |
| Cladribine 10 mg/10 ml intravenous solution HCPCS J9065 | not published | not published | $11.22 – $30.69 | 5 |
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.