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 |
|---|---|---|---|---|
| Clamp isol transpolr 5mmx6.5cm transpolar HCPCS C1733 | $8,873.40 | $16,133.46 | not published | 0 |
| Claviculectomy partial CPT 23120 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Claviculectomy total CPT 23125 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Clean out mastoid cavity CPT 69222 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clearance of airways CPT 31720 | $121.55 | $221.00 | $1,887.00 – $2,654.00 | 3 |
| Clearance of tear duct CPT 68530 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clindamycin 600 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J0736 | not published | not published | $1.77 – $5.79 | 5 |
| Clip ligating vesolock lg HCPCS C1760 | $490.88 | $892.50 | not published | 0 |
| Clitoroplasty intersex state CPT 56805 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Clofarabine 1 mg/ml intravenous solution HCPCS J9027 | not published | not published | $9.15 – $27.96 | 5 |
| Clonidine (pf) 1,000 mcg/10 ml (100 mcg/ml) epidural solution HCPCS J0735 | not published | not published | $17.82 – $45.57 | 5 |
| Close bronchial fistula 32815 CPT 32815 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Closed carpo/metacarpal disl thumb w/manip CPT 26641 | $492.25 | $895.00 | $1,887.00 – $2,654.00 | 3 |
| Closed carpo/metacarpal fx disl thumb w/manip CPT 26645 | not published | not published | $1,887.00 – $3,388.00 | 3 |
| Closed treatment of femoral fracture proximal end neck; wi CPT 27232 | not published | not published | $2,654.00 – $4,761.00 | 3 |
| Closed tx/acetabululm without manip 27220 CPT 27220 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Closed tx humerus fx with manip 23605 CPT 23605 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Closed tx humerus fx without manip 23600 CPT 23600 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Closed tx humerus fx w/manip 24505 CPT 24505 | $803.55 | $1,461.00 | $1,887.00 – $3,388.00 | 3 |
| Closed tx metatarsophalangeal jnt disl without anes CPT 28630 | $526.35 | $957.00 | $1,887.00 – $2,654.00 | 3 |
| Closed tx nose/jaw fx CPT 21345 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Closed tx orbit without manipulj CPT 21400 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Closed tx orbit w/manipulj CPT 21401 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Closed tx post hip arthroplasty disloc w/anes 27266 CPT 27266 | $3,069.00 | $5,580.00 | $3,388.00 – $4,761.00 | 3 |
| Closed tx septal&nose fx CPT 21337 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Closed tx sesamoid fx 28530 CPT 28530 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Closed tx/talus fracture without manip 28430 CPT 28430 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Closed tx vert fx w/manj CPT 22315 | not published | not published | $3,579.00 – $4,761.00 | 3 |
| Close lac/mouth vest/2.5 cm or < 40830 CPT 40830 | $481.80 | $876.00 | $1,887.00 – $2,654.00 | 3 |
| Close mastoid fistula CPT 69700 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Close median sternotomy separation 21750 CPT 21750 | not published | not published | $3,735.00 – $18,364.00 | 3 |
| Close tear duct opening CPT 68760 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Close tear duct opening CPT 68761 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Close tear system fistula CPT 68770 | not published | not published | $2,959.00 – $3,388.00 | 3 |
| Clostridium toxin a w/optic CPT 87803 | not published | not published | $16.00 – $28.00 | 4 |
| Clos txnose fx without stablz 21315 CPT 21315 | $4,488.55 | $8,161.00 | $3,388.00 – $4,761.00 | 3 |
| Closure enterostomy lg/sm intestine 44620 CPT 44620 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Closure enterostomy lg/sm intestine anast 44626 CPT 44626 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Closure enterostomy lg/sm intestine oth/thn 44625 CPT 44625 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Closure intestinal cutaneous fistula 44640 CPT 44640 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Closure laceration vestibule mouth > 2.5 cm cmplx CPT 40831 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Closure of eyelid by suture CPT 67875 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Closure of salivary fistula CPT 42600 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Closure of windpipe lesion 31820 CPT 31820 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Closure paravalvlr leak pq CPT 33999 | $23,443.20 | $42,624.00 | $2,959.00 – $10,779.00 | 3 |
| Clot factor fletcher fact CPT 85292 | not published | not published | $18.93 – $38.32 | 4 |
| Clot factor viii reltd antgn CPT 85244 | not published | not published | $20.42 – $41.32 | 4 |
| Clot factor wght kininogen CPT 85293 | not published | not published | $18.93 – $38.32 | 4 |
| Clot factor xii hageman CPT 85280 | $169.40 | $308.00 | $19.35 – $39.14 | 4 |
| Clot factor xiii fibrin scrn CPT 85291 | $15.95 | $29.00 | $9.11 – $18.00 | 4 |
| Clot factor xiii fibrin stab CPT 85290 | not published | not published | $16.34 – $33.06 | 4 |
| Clotting assay whole blood CPT 85396 | not published | not published | $20.93 – $30.47 | 2 |
| Clsd/shoulder dislo/manip/no anest 23650 CPT 23650 | $1,026.30 | $1,866.00 | $1,887.00 – $2,654.00 | 3 |
| Clsd tx bimalleol ank fx without manip 27808 CPT 27808 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx carpo/metacarpl disl thmb manip ea without anes CPT 26670 | $448.80 | $816.00 | $1,887.00 – $2,654.00 | 3 |
| Clsd tx clav dislc without manip 23520 CPT 23520 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Clsd tx clavicle dislocation without manip 23540 CPT 23540 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx clavicle fracture w/manip 23505 CPT 23505 | not published | not published | $2,959.00 – $3,388.00 | 3 |
| Clsd tx/clavicular fx without manip 23500 CPT 23500 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx coccygeal fracture 27200 CPT 27200 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx/dis phalan fx without manip/ea 26750 CPT 26750 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx dist fib fx w/manip 27788 CPT 27788 | $631.40 | $1,148.00 | $1,887.00 – $2,654.00 | 3 |
| Clsd tx/dis tib/wt bear no manip 27824 CPT 27824 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx elbow dislocation child 24640 CPT 24640 | $526.35 | $957.00 | $1,887.00 – $2,654.00 | 3 |
| Clsd tx/fem shaft fx/manipulation 27502 CPT 27502 | $2,118.05 | $3,851.00 | $3,388.00 – $4,761.00 | 3 |
| Clsd tx finger tendon w/wo perq pin 26432 CPT 26432 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Clsd tx fracture of radius 25500 CPT 25500 | $492.25 | $895.00 | $1,887.00 – $2,654.00 | 3 |
| Clsd tx/fx grt toe/phalanx/phalang 28490 CPT 28490 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx/fx/phalanx/phalang/manip 28515 CPT 28515 | $526.35 | $957.00 | $1,887.00 – $2,654.00 | 3 |
| Clsd tx fx radius/ulna dist without manip 25600 CPT 25600 | $391.05 | $711.00 | $1,887.00 – $2,654.00 | 3 |
| Clsd tx fx radius/ulna dist w/manip 25605 CPT 25605 | $3,069.00 | $5,580.00 | $2,959.00 – $3,388.00 | 3 |
| Clsd tx fx radius/ulna without manip 25560 CPT 25560 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx fx radius/ulna w/manip 25565 CPT 25565 | $3,092.10 | $5,622.00 | $1,887.00 – $3,388.00 | 3 |
| Clsd tx/grt hum tube fx without manip 23620 CPT 23620 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx hip disloc without anes 27265 CPT 27265 | $1,306.80 | $2,376.00 | $1,887.00 – $2,654.00 | 3 |
| Clsd tx humeral fract without manip 24530 CPT 24530 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx humerus fract without manip 24500 CPT 24500 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx iphal jnt disl w/manip req anes CPT 26775 | $628.10 | $1,142.00 | $1,887.00 – $2,654.00 | 3 |
| Clsd tx mandibular fx without manip 21450 CPT 21450 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx/metacar/interphal artic fx 26740 CPT 26740 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx/metacarpal fx/sg without manip 26600 CPT 26600 | $498.85 | $907.00 | $1,887.00 – $2,654.00 | 3 |
| Clsd tx/metacarpal fx/sng/w manip 26605 CPT 26605 | $526.35 | $957.00 | $1,887.00 – $2,654.00 | 3 |
| Clsd tx metacarp fx w/manip&ext fix ea bone 26607 CPT 26607 | not published | not published | $3,579.00 – $4,761.00 | 3 |
| Clsd tx metatarsal fracture w/manip 28475 CPT 28475 | $374.00 | $680.00 | $1,887.00 – $2,654.00 | 3 |
| Clsd tx/metatarsal fx without manip 28470 CPT 28470 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx/nasal bone fx/stabilize 21320 CPT 21320 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Clsd tx of ankle fracture w/manip 28435 CPT 28435 | $3,152.05 | $5,731.00 | $3,388.00 – $4,761.00 | 3 |
| Clsd tx patella disloc without anes 27560 CPT 27560 | $523.05 | $951.00 | $1,887.00 – $2,654.00 | 3 |
| Clsd tx/patellar fx without manip 27520 CPT 27520 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx pelvic ring fx CPT 27197 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Clsd tx pelvic ring fx CPT 27198 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Clsd tx prox fib/shaft fx w/manip 27781 CPT 27781 | $3,372.60 | $6,132.00 | $2,959.00 – $3,388.00 | 3 |
| Clsd tx/prox/mid phalnx fx/no manp 26720 CPT 26720 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx/radial head/neck fx/no manip 24650 CPT 24650 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx radius fracture w/manip 24655 CPT 24655 | $3,152.05 | $5,731.00 | $1,887.00 – $3,388.00 | 3 |
| Clsd tx/scapular fx without manip 23570 CPT 23570 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Clsd tx shoulder dislc/fx 23665 CPT 23665 | $3,069.00 | $5,580.00 | $2,959.00 – $3,388.00 | 3 |
| Clsd tx shoulder disloc w/anatom neck fx w/manip 23675 CPT 23675 | $3,152.05 | $5,731.00 | $1,887.00 – $3,388.00 | 3 |
| Clsd tx/shoulder dislo/manip/anest 23655 CPT 23655 | $3,069.00 | $5,580.00 | $3,388.00 – $4,761.00 | 3 |
| Clsd tx/talotarsal dislocat/anes 28575 CPT 28575 | not published | not published | $3,579.00 – $4,761.00 | 3 |
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.