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 |
|---|---|---|---|---|
| Administration immunization each additional vaccine CPT 90472 | $43.45 | $79.00 | not published | 0 |
| Administration rsv monoclonal ab seasonal dose im w/counseling CPT 96380 | $51.70 | $94.00 | not published | 0 |
| Administration vaccine hepatitis b HCPCS G0010 | $35.20 | $64.00 | not published | 0 |
| Administration vaccine influenza virus HCPCS G0008 | $49.50 | $90.00 | not published | 0 |
| Administration vaccine pneumococcal HCPCS G0009 | $49.50 | $90.00 | not published | 0 |
| Administration vaccine rsv monoclonal ab seasonal dose im CPT 96381 | $48.95 | $89.00 | not published | 0 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | not published | not published | $44.35 – $111.54 | 5 |
| Adrenal cortex & medulla img CPT 78075 | not published | not published | $1,355.68 – $1,355.68 | 1 |
| Adrenalectomy expl w/exc retro tumor 60545 CPT 60545 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Afamelanotide implant, 1 mg HCPCS J7352 | not published | not published | $7,822.63 – $7,822.63 | 1 |
| _afb id by dna probe rflx ast CPT 87149 | $96.80 | $176.00 | $20.05 – $40.58 | 4 |
| #afb mycobacteria suscep. #1 CPT 87190 | not published | not published | $5.83 – $12.79 | 4 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | $564.85 | $1,027.00 | $115.36 – $233.44 | 4 |
| Aflibercept injection HCPCS J0178 | not published | not published | $867.33 – $2,180.92 | 5 |
| After cataract laser surgery CPT 66821 | not published | not published | $2,654.00 – $3,030.00 | 3 |
| Agalsidase beta 35 mg intravenous solution HCPCS J0180 | not published | not published | $242.00 – $608.54 | 5 |
| Air injection into abdomen 49400 CPT 49400 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Albumin body fluid quantitative each specimen CPT 82042 | $33.00 | $60.00 | $7.78 – $13.62 | 4 |
| Albumin (human), 25%, 50ml HCPCS P9047 | not published | not published | $58.39 – $144.51 | 4 |
| Albumin, human 25 % intravenous solution HCPCS P9046 | not published | not published | $23.35 – $57.80 | 4 |
| Albumin (human), 5%, 250 ml HCPCS P9045 | not published | not published | $58.39 – $144.51 | 4 |
| Albumin, human 5 % intravenous solution HCPCS P9041 | not published | not published | $11.68 – $28.91 | 4 |
| Albumin ischemia modified CPT 82045 | not published | not published | $33.94 – $68.69 | 4 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $46.20 | $84.00 | $5.78 – $11.69 | 4 |
| Albumin serum plasma or whole blood CPT 82040 | $47.85 | $87.00 | $4.95 – $10.01 | 4 |
| Albuterol ipratrop non-comp HCPCS J7620 | not published | not published | $0.20 – $0.51 | 5 |
| Albuterol non-comp con HCPCS J7611 | not published | not published | $0.17 – $0.43 | 5 |
| Albuterol non-comp unit HCPCS J7613 | not published | not published | $0.08 – $0.20 | 5 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $31.35 | $57.00 | $17.27 – $30.22 | 4 |
| Aldesleukin injection HCPCS J9015 | not published | not published | $14,432.68 – $14,432.68 | 1 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | not published | not published | $2,613.00 – $6,570.37 | 5 |
| Alkaline phosphatase CPT 84075 | $45.65 | $83.00 | $5.18 – $10.48 | 4 |
| Allergen alpha lactalbumin ige CPT 86008 | $29.70 | $54.00 | $17.93 – $32.89 | 4 |
| Allergen egg white ige CPT 86003 | $26.40 | $48.00 | $5.22 – $9.14 | 4 |
| Allergen specific ige qual multi scrn ea CPT 86005 | $64.35 | $117.00 | $7.97 – $16.14 | 4 |
| Allergy injections; 2 or more 95117 CPT 95117 | $30.25 | $55.00 | not published | 0 |
| Allgrft implnt knee w/scope CPT 29867 | not published | not published | $7,609.00 – $18,364.00 | 3 |
| Allograft allowrap 4x4cm dry 16sqcm HCPCS Q4150 | not published | not published | $91.04 – $236.05 | 4 |
| Allograft amnioexcel plus 17mm disk HCPCS Q4137 | not published | not published | $112.40 – $317.66 | 4 |
| Allograft dermis 20x25x1mm decell w/matracell arthroflex HCPCS Q4125 | $3,317.32 | $6,031.50 | not published | 0 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | not published | not published | $26.92 – $83.28 | 4 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | not published | not published | $174.16 – $431.05 | 4 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | not published | not published | $371.55 – $371.55 | 1 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | not published | not published | $141.27 – $347.14 | 4 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | not published | not published | $271.72 – $660.83 | 4 |
| Alloskin HCPCS Q4115 | not published | not published | $13.62 – $41.25 | 4 |
| Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution HCPCS J0256 | not published | not published | $5.51 – $13.86 | 5 |
| Alpha-fetoprotein afp-l3 frac & total CPT 82107 | not published | not published | $64.41 – $130.33 | 4 |
| Alpha-fetoprotein amniotic CPT 82106 | not published | not published | $17.00 – $33.95 | 4 |
| Alpha-fetoprotein tumor marker CPT 82105 | $147.95 | $269.00 | $16.77 – $33.95 | 4 |
| Alprostadil for injection HCPCS J0270 | not published | not published | $1.29 – $1.29 | 1 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | not published | not published | $99.05 – $249.05 | 5 |
| Alt/sgpt CPT 84460 | $50.05 | $91.00 | $5.30 – $10.73 | 4 |
| Altuviiio per factor viii iu HCPCS J7214 | not published | not published | $5.02 – $12.64 | 5 |
| Aluminum - quest CPT 82108 | $386.65 | $703.00 | $25.48 – $51.56 | 4 |
| Alveoloplasty each quadrant CPT 41874 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Amantadine (symmetrel)-sendout CPT 80375 | $188.65 | $343.00 | $35.06 – $35.06 | 1 |
| Amikacin 4 mg/ml intravitreal injection - cnr HCPCS J0278 | not published | not published | $0.58 – $1.47 | 5 |
| Amino acid screen, urine CPT 82128 | not published | not published | $13.87 – $28.07 | 4 |
| Amino acid single qual CPT 82127 | not published | not published | $14.18 – $28.07 | 4 |
| Amino acids quant 2-5 CPT 82136 | not published | not published | $19.61 – $34.32 | 4 |
| Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr HCPCS J0281 | not published | not published | $1.43 – $2.84 | 2 |
| Aminolevulinic acid, 10% gel HCPCS J7345 | not published | not published | $1.86 – $4.69 | 5 |
| Aminolevulinic acid delta CPT 82135 | $145.20 | $264.00 | $16.45 – $33.30 | 4 |
| Aminolevulinic acid hcl top HCPCS J7308 | not published | not published | $427.96 – $1,076.10 | 5 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | not published | not published | $5.60 – $15.77 | 5 |
| Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV HCPCS J0283 | not published | not published | $2.73 – $6.86 | 5 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | not published | not published | $0.36 – $1.06 | 5 |
| Amitriptyline (elavil) -sendout CPT 80335 | $194.70 | $354.00 | $35.06 – $35.06 | 1 |
| Amivantamab-vmjw 50 mg/ml intravenous solution HCPCS J9061 | not published | not published | $23.34 – $58.69 | 5 |
| Ammonia CPT 82140 | $126.50 | $230.00 | $14.57 – $29.50 | 4 |
| Amniocentesisdiagnostic 59000 CPT 59000 | not published | not published | $2,654.00 – $3,030.00 | 3 |
| Amniocentesis therapeutic CPT 59001 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Amniotic fluid scan CPT 82143 | not published | not published | $9.35 – $16.36 | 4 |
| Amp f/th 1/2 jt/phalanx w/neurect local flap CPT 26952 | not published | not published | $3,579.00 – $4,761.00 | 3 |
| Amphetamine confirm urine -sendout CPT 80324 | $188.65 | $343.00 | $35.06 – $35.06 | 1 |
| Amphetamines 5 or more CPT 80326 | $188.65 | $343.00 | not published | 0 |
| Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J0285 | not published | not published | $54.21 – $136.32 | 5 |
| Amphotericin b lipid complex HCPCS J0287 | not published | not published | $11.33 – $28.05 | 3 |
| Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J0289 | not published | not published | $25.64 – $65.29 | 5 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | not published | not published | $0.66 – $1.93 | 5 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | not published | not published | $1.73 – $4.47 | 5 |
| Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis CPT 81515 | not published | not published | $262.99 – $460.23 | 4 |
| Amp metatarsal w/toe single 28810 CPT 28810 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Amp thigh through femur re-amp 27596 CPT 27596 | not published | not published | $3,735.00 – $18,364.00 | 3 |
| Amputate hand at wrist CPT 25922 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Amputate metacarpal bone 26910 CPT 26910 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Amputate thigh through femur 27590 CPT 27590 | not published | not published | $3,735.00 – $27,583.00 | 3 |
| Amputation follow-up surgery CPT 24925 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Amputation follow-up surgery CPT 25907 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Amputation follow-up surgery CPT 25909 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Amputation follow-up surgery CPT 25929 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Amputation follow-up surgery CPT 25931 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Amputation follow-up surgery CPT 27594 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Amputation follow-up surgery CPT 27884 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Amputation leg thr tib/fib 27880 CPT 27880 | not published | not published | $3,735.00 – $27,583.00 | 3 |
| Amputation leg; tib/fib f/u 27886 CPT 27886 | not published | not published | $3,735.00 – $18,364.00 | 3 |
| Amputation of foot at ankle CPT 27889 | not published | not published | $6,779.00 – $8,770.00 | 3 |
| Amputation of lower leg CPT 27882 | not published | not published | $3,735.00 – $18,364.00 | 3 |
| Amputation of midtarsal 28800 CPT 28800 | not published | not published | $6,779.00 – $8,770.00 | 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.