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 |
|---|---|---|---|---|
| Cystoscopy and treatment CPT 52290 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Cystoscopy and treatment CPT 52300 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Cystoscopy and treatment CPT 52301 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Cystoscopy and treatment CPT 52305 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Cystoscopy and treatment CPT 52310 | $2,867.70 | $5,214.00 | $3,388.00 – $4,761.00 | 3 |
| Cystoscopy and treatment CPT 52315 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Cystoscopy and treatment CPT 52320 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Cystoscopy and treatment CPT 52330 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Cystoscopy (Bladder Scope) CPT 52000 | $851.40 | $1,548.00 | $2,654.00 – $3,030.00 | 3 |
| Cystoscopy chemodenervation CPT 52287 | $882.83 | $1,605.15 | $3,388.00 – $4,761.00 | 3 |
| Cystoscopy & duct catheter CPT 52010 | not published | not published | $2,654.00 – $3,030.00 | 3 |
| Cystoscopy implant stent CPT 52282 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Cystoscopy inject material CPT 52327 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Cystoscopy prostatic imp 1-3 HCPCS C9739 | not published | not published | $7,529.00 – $7,791.00 | 2 |
| Cystoscopy removal of clots CPT 52001 | $856.68 | $1,557.60 | $3,579.00 – $4,761.00 | 3 |
| Cystoscopy & revise urethra CPT 52270 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Cystoscopy & revise urethra CPT 52275 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Cystoscopy stone removal CPT 52325 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Cystoscopy & ureter catheter CPT 52005 | $2,695.55 | $4,901.00 | $3,388.00 – $7,791.00 | 3 |
| Cystostomy cystotomy w/drainage 51040 CPT 51040 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Cystotomy/cystostomy fulg+/insj radact matrl 51020 CPT 51020 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Cystotomy excise/incise/repair 51535 CPT 51535 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Cystouretero & or pyeloscope CPT 52351 | $1,306.14 | $2,374.80 | $3,388.00 – $7,791.00 | 3 |
| Cysto/uretero stricture tx CPT 52344 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Cystouretero w/biopsy CPT 52354 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Cystouretero w/excise tumor CPT 52355 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Cysto/uretero w/lithotripsy CPT 52356 | $2,807.97 | $5,105.40 | $4,428.00 – $16,106.00 | 3 |
| Cystouretero w/lithotripsy CPT 52353 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Cystouretero w/renal strict CPT 52346 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Cystouretero w/stone remove CPT 52352 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Cysto/uretero w/up stricture CPT 52345 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Cystourethro cut ejacul duct CPT 52402 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Cystourethroscop/calib/dilat stric 52281 CPT 52281 | $2,727.45 | $4,959.00 | $3,388.00 – $4,761.00 | 3 |
| Cystourethroscopy w/biopsy(s) 52204 CPT 52204 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| 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 | $3,388.00 – $7,791.00 | 3 |
| Cysto w/up stricture tx CPT 52342 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Cysto w/ureter stricture tx CPT 52341 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| 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 | $42.38 – $74.17 | 4 |
| Cytogenetics 3-5 CPT 88272 | not published | not published | $40.70 – $71.23 | 4 |
| Cytogenomic neo microra alys CPT 81277 | not published | not published | $1,160.00 – $2,030.00 | 4 |
| Cytogenom microarray copy nmbr var CPT 81228 | not published | not published | $900.00 – $1,575.00 | 4 |
| Cytomegalovirus (cmv) antibody igg CPT 86644 | $83.60 | $152.00 | $14.39 – $29.12 | 4 |
| Cytomegalovirus (cmv) antibody igm CPT 86645 | $695.75 | $1,265.00 | $11.77 – $29.49 | 4 |
| Cytomegalovirus dfa CPT 87271 | not published | not published | $13.42 – $24.26 | 4 |
| Cytomegalovirus imm IV /vial HCPCS J0850 | not published | not published | $1,964.18 – $4,938.91 | 5 |
| Cyto/molecular report CPT 88291 | $79.20 | $144.00 | $34.65 – $46.56 | 2 |
| Cytopath c/v auto in fluid CPT 88174 | not published | not published | $25.37 – $44.40 | 4 |
| Cytopath c/v index add-on CPT 88155 | not published | not published | $12.12 – $25.64 | 4 |
| Cytopath fl nongyn filter CPT 88106 | not published | not published | $22.99 – $78.06 | 2 |
| Cytopathology cellular enhancement technique non-gyn CPT 88112 | $248.60 | $452.00 | $49.47 – $61.28 | 2 |
| Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review CPT 88175 | $212.30 | $386.00 | $26.61 – $53.35 | 4 |
| Cytopathology cervical/vaginal thin layer manual screening CPT 88142 | $172.15 | $313.00 | $20.26 – $40.98 | 4 |
| Cytopathology concentration technique smears & interpretation CPT 88108 | $177.10 | $322.00 | $33.43 – $69.94 | 2 |
| Cytopathology fluids/washings/brushings smears with interpretation CPT 88104 | $239.80 | $436.00 | $33.43 – $65.86 | 2 |
| Cytopathology fna adequacy evaluation each separate additional episode same site CPT 88177 | $61.60 | $112.00 | $7.22 – $10.68 | 2 |
| Cytopathology fna adequacy evaluation first episode each site CPT 88172 | $262.90 | $478.00 | $28.26 – $143.50 | 2 |
| Cytopathology fna adequacy evaluation first episode each site interp/rpt CPT 88173 | $262.90 | $478.00 | $49.47 – $114.96 | 2 |
| Cytopath smear other source CPT 88160 | not published | not published | $22.99 – $64.87 | 2 |
| Cytopath smear other source CPT 88162 | not published | not published | $49.47 – $91.08 | 2 |
| Cytopath smear oth prep screen & interp CPT 88161 | $56.65 | $103.00 | $22.99 – $55.72 | 2 |
| Cytopath tbs c/v manual CPT 88164 | not published | not published | $15.12 – $31.83 | 4 |
| Cytotoxic antibody screening CPT 86807 | $129.80 | $236.00 | $78.65 – $137.64 | 4 |
| Cytotoxic antibody screening CPT 86808 | not published | not published | $29.68 – $60.05 | 4 |
| Cytp urine 3-5 probes cmptr CPT 88121 | $736.45 | $1,339.00 | $283.41 – $717.97 | 2 |
| Dacarbazine 100 mg intravenous solution HCPCS J9130 | not published | not published | $4.52 – $11.35 | 5 |
| Dactinomycin 0.5 mg intravenous solution HCPCS J9120 | not published | not published | $317.68 – $884.27 | 5 |
| Dalbavancin 500 mg intravenous solution HCPCS J0875 | not published | not published | $16.89 – $42.47 | 5 |
| Dalteparin sodium HCPCS J1645 | not published | not published | $15.01 – $37.74 | 5 |
| Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 | not published | not published | $0.03 – $0.12 | 5 |
| Daptomycin (xellia) unrefrig HCPCS J0872 | not published | not published | $0.05 – $0.12 | 5 |
| Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln HCPCS J9144 | not published | not published | $55.63 – $139.90 | 5 |
| Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe HCPCS J0881 | not published | not published | $3.21 – $8.09 | 5 |
| Darbepoetin alfa, esrd use HCPCS J0882 | not published | not published | $3.21 – $8.09 | 5 |
| Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution HCPCS J9153 | not published | not published | $268.96 – $676.30 | 5 |
| Daunorubicin 5 mg/ml intravenous solution HCPCS J9150 | not published | not published | $25.46 – $64.04 | 5 |
| Dbrdmt prmlg les w/pdt CPT 96574 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| D&c after delivery 59160 CPT 59160 | $4,616.15 | $8,393.00 | $3,388.00 – $7,791.00 | 3 |
| D&c/diagnostic/therapeutic/non ob 58120 CPT 58120 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Dch glucoscan CPT 82948 | not published | not published | $5.04 – $8.82 | 4 |
| Dch validity tests CPT 81002 | not published | not published | $3.48 – $6.09 | 4 |
| Dcm pq ndl dsk sgl/mlt lv lmbr w/guide CPT 62287 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Dcmprn orbit only transcrnl CPT 61330 | not published | not published | $3,388.00 – $16,106.00 | 3 |
| Dcmprn plantar digital nerve CPT 64726 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| D&c of cervical stump CPT 57558 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Deamidated gliadin antibody iga CPT 86258 | $70.40 | $128.00 | $11.53 – $21.09 | 4 |
| Debr g/per/abd wall 11006 CPT 11006 | not published | not published | $2,654.00 – $2,654.00 | 1 |
| Debrid ecz/inf skin up tp 10% body 11000 CPT 11000 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Debridement (>20 cm) charge pt CPT 97598 | $245.30 | $446.00 | $1,887.00 – $2,334.00 | 2 |
| Debridement bone <= 20 sq cm CPT 11044 | $2,257.20 | $4,104.00 | $2,959.00 – $3,388.00 | 3 |
| Debridement/bone/20 sq cm or less 11046 CPT 11046 | $759.55 | $1,381.00 | $1,887.00 – $5,512.00 | 3 |
| Debridement/bone/ea add 20 sq cm 11047 CPT 11047 | $1,197.90 | $2,178.00 | $1,887.00 – $5,512.00 | 3 |
| Debridement subcutaneous tissue <= 20 sq cm CPT 11042 | $950.40 | $1,728.00 | $1,887.00 – $2,654.00 | 3 |
| Debride nail1-5 11720 CPT 11720 | $215.60 | $392.00 | $1,887.00 – $2,654.00 | 3 |
| Debride nail6 or more 11721 CPT 11721 | $215.60 | $392.00 | $1,887.00 – $2,654.00 | 3 |
| Debride/rmv fb/open fx/skin/sq/musc11011 CPT 11011 | not published | not published | $2,654.00 – $3,030.00 | 3 |
| Debride skin bone at fx site CPT 11012 | not published | not published | $2,959.00 – $3,735.00 | 3 |
| Debride skn/sq/musc/abd wall 11004 CPT 11004 | not published | not published | $2,654.00 – $2,654.00 | 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.