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 |
|---|---|---|---|---|
| Dlyd plmt xtn prosth ea addl CPT 34711 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Dmd dup/delet analysis CPT 81161 | not published | not published | $208.18 – $488.25 | 4 |
| Dmpk gene detc abnor allele CPT 81234 | not published | not published | $137.00 – $239.75 | 4 |
| Dna antibody native/double stranded CPT 86225 | $115.50 | $210.00 | $13.74 – $27.79 | 4 |
| Dna gardnerella CPT 87510 | not published | not published | $20.05 – $40.58 | 4 |
| Dna probe chlamydia CPT 87490 | not published | not published | $22.75 – $40.58 | 4 |
| Dna probe gc CPT 87590 | not published | not published | $26.88 – $47.04 | 4 |
| Dna trichomonas CPT 87660 | not published | not published | $20.05 – $40.58 | 4 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | not published | not published | $8.00 – $20.11 | 5 |
| Docetaxel 20 mg/ml intravenous solution (wrapper) HCPCS J9171 | not published | not published | $0.67 – $1.98 | 5 |
| Docetaxel (docivyx), 1 mg HCPCS J9172 | not published | not published | $56.53 – $142.15 | 5 |
| Dolasetron mesylate HCPCS J1260 | not published | not published | $9.69 – $9.69 | 1 |
| Dolasetron mesylate oral HCPCS Q0180 | not published | not published | $391.41 – $391.41 | 1 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | not published | not published | $0.78 – $2.10 | 5 |
| Doppler echo complete CPT 93320 | $424.60 | $772.00 | not published | 0 |
| Doppler intravascular pressure flow initial vessel CPT 93571 | $2,637.25 | $4,795.00 | $1,887.00 – $2,334.00 | 2 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $552.75 | $1,005.00 | not published | 0 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $538.45 | $979.00 | not published | 0 |
| Doripenem 50 mg/ml inj 10 ml HCPCS J1267 | not published | not published | $1.77 – $1.77 | 1 |
| Dornase alfa non-comp unit HCPCS J7639 | not published | not published | $58.02 – $145.89 | 5 |
| Dostarlimab-gxly 50 mg/ml intravenous solution HCPCS J9272 | not published | not published | $259.92 – $653.57 | 5 |
| Doxorubicin 2 mg/ml intravenous solution (wrapper) HCPCS J9000 | not published | not published | $3.47 – $9.04 | 5 |
| Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension HCPCS Q2050 | not published | not published | $165.45 – $370.39 | 4 |
| Doxycycline hyclate 100 mg intravenous powder for solution HCPCS J1271 | not published | not published | $0.13 – $0.22 | 2 |
| Dpyd gene common variants CPT 81232 | $464.75 | $845.00 | $174.81 – $305.92 | 4 |
| Drainage absc/cyst/hmtma/vestibule mouth smpl CPT 40800 | $1,354.10 | $2,462.00 | $2,654.00 – $3,030.00 | 3 |
| Drainage ext aud canal abscess 69020 CPT 69020 | $1,489.40 | $2,708.00 | $2,654.00 – $3,030.00 | 3 |
| Drainage external ear complex 69005 CPT 69005 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Drainage external ear simple 69000 CPT 69000 | $1,489.40 | $2,708.00 | $2,654.00 – $3,030.00 | 3 |
| Drainage lymph node lesion 38300 CPT 38300 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Drainage lymph node lesion 38305 CPT 38305 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Drainage mouth roof lesion CPT 42000 | $481.80 | $876.00 | $1,887.00 – $2,654.00 | 3 |
| Drainage of arm bursa 23931 CPT 23931 | $2,599.30 | $4,726.00 | $3,388.00 – $4,761.00 | 3 |
| Drainage of bladder abscess CPT 51080 | not published | not published | $3,579.00 – $4,761.00 | 3 |
| Drainage of eye CPT 65800 | not published | not published | $1,887.00 – $3,388.00 | 3 |
| Drainage of eye CPT 65810 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Drainage of eye CPT 65815 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Drainage of forearm bursa CPT 25031 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Drainage of kidney lesion CPT 50390 | $1,617.55 | $2,941.00 | $2,654.00 – $3,030.00 | 3 |
| Drainage of mouth lesion CPT 41005 | $647.90 | $1,178.00 | $1,887.00 – $2,654.00 | 3 |
| Drainage of mouth lesion CPT 41006 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Drainage of mouth lesion CPT 41007 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Drainage of mouth lesion CPT 41008 | $6,171.55 | $11,221.00 | $3,388.00 – $4,761.00 | 3 |
| Drainage of mouth lesion CPT 41009 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Drainage of mouth lesion CPT 41015 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Drainage of mouth lesion CPT 41016 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Drainage of mouth lesion CPT 41017 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Drainage of mouth lesion CPT 41018 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Drainage of nose lesion int 30000 CPT 30000 | $451.00 | $820.00 | $1,887.00 – $2,654.00 | 3 |
| Drainage of nose lesion sept 30020 CPT 30020 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Drainage of pelvis bursa CPT 26991 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Drainage of pelvis lesion 26990 CPT 26990 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Drainage of prostate abscess CPT 52700 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Drainage of prostate abscess CPT 55720 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Drainage of prostate abscess CPT 55725 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Drainage of rectal abscess CPT 45005 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Drainage of rectal abscess 45020 CPT 45020 | $5,915.80 | $10,756.00 | $3,388.00 – $4,761.00 | 3 |
| Drainage of salivary gland CPT 42305 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Drainage of salivary gland CPT 42320 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Drainage of throat abscess CPT 42725 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Drainage of urethra abscess CPT 53040 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Drainage of urethra abscess 53060 CPT 53060 | $2,959.00 | $5,380.00 | $3,388.00 – $7,791.00 | 3 |
| Drainage of urinary leakage CPT 53080 | not published | not published | $2,654.00 – $7,791.00 | 3 |
| Drainage of urinary leakage CPT 53085 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Drain bladder by trocar/cath CPT 51101 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Drain blood from under nail 11740 CPT 11740 | $248.05 | $451.00 | $1,887.00 – $2,654.00 | 3 |
| Drain cath image guided peri/retroperitoneal transvag/transrectal CPT 49407 | $2,529.45 | $4,599.00 | $3,388.00 – $4,761.00 | 3 |
| Drain cath image guided visceral pq CPT 49405 | $2,885.30 | $5,246.00 | $3,388.00 – $4,761.00 | 3 |
| Drain cerebro spinal fluid 62272 CPT 62272 | $1,234.20 | $2,244.00 | $2,654.00 – $3,030.00 | 3 |
| Drain chest lesion CPT 21502 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Drain finger abscess;simple 26010 CPT 26010 | $565.95 | $1,029.00 | $1,887.00 – $2,654.00 | 3 |
| Drain lower leg bursa CPT 27604 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Drain lower leg lesion 27603 CPT 27603 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Drain neck/chest lesion 21501 CPT 21501 | $2,160.40 | $3,928.00 | $3,735.00 – $7,791.00 | 3 |
| Drain open lung lesion 32200 CPT 32200 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Drain ovarn cyst abd CPT 58805 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Drain ovary abscess open CPT 58820 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Drain pancreatic pseudocyst 48510 CPT 48510 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Drain penis lesion CPT 54015 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Drain shoulder bone lesion CPT 23035 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Drain shoulder bursa 23031 CPT 23031 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Drain shoulder lesion CPT 23030 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Drain thigh/knee lesion 27301 CPT 27301 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Drain thyroid/tongue cyst CPT 60000 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Drain to peritoneal cavity CPT 49062 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $605.55 | $1,101.00 | $1,887.00 – $2,654.00 | 3 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $569.80 | $1,036.00 | $1,887.00 – $2,654.00 | 3 |
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | $626.45 | $1,139.00 | $1,887.00 – $2,654.00 | 3 |
| Dressing change not for burn w/anes 15852 CPT 15852 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm HCPCS Q4108 | not published | not published | $55.53 – $122.08 | 4 |
| Drill hole evac+/drg subdural hematoma 61108 CPT 61108 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Drill hole implt ventricular cath/device 61107 CPT 61107 | $1,532.85 | $2,787.00 | $3,388.00 – $3,388.00 | 1 |
| Drng appendix abscess open 44900 CPT 44900 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Drng hand tendon sheath 26020 CPT 26020 | not published | not published | $3,579.00 – $4,761.00 | 3 |
| Drng of eyelid abscess 67700 CPT 67700 | $870.65 | $1,583.00 | $1,887.00 – $2,654.00 | 3 |
| Drng of finger abscess comp 26011 CPT 26011 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Drng of hydrocele 55000 CPT 55000 | not published | not published | $2,654.00 – $3,030.00 | 3 |
| Drng of mouth lesion 40801 CPT 40801 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Drng of ovarian cyst(s) 58800 CPT 58800 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Drng of palm multi bursas 26030 CPT 26030 | 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.