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 |
|---|---|---|---|---|
| Drng of palm single bursa 26025 CPT 26025 | not published | not published | $3,579.00 – $4,761.00 | 3 |
| Drng of pelvic abscess transrectal 45000 CPT 45000 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Drng of salivary cyst 42409 CPT 42409 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Drng of scrotum abscess 55100 CPT 55100 | $3,131.70 | $5,694.00 | $3,388.00 – $4,761.00 | 3 |
| Drng open retroperitoneal abscess 49060 CPT 49060 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Drng open subdiaphragmatic/subphrenic absc 49040 CPT 49040 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Drng ovary abscess perqt 58822 CPT 58822 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Drng peritoneal abscess open 49020 CPT 49020 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Drng salivary gland simple 42300 CPT 42300 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Drng salivary gland submax/subling 42310 CPT 42310 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Dronabinol 2.5mg oral HCPCS Q0167 | not published | not published | $1.63 – $5.03 | 4 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | not published | not published | $9.43 – $33.18 | 3 |
| Drsg interceed 3x4in adh wnd barr absorb HCPCS C1765 | $343.73 | $624.96 | not published | 0 |
| Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm HCPCS Q4103 | not published | not published | $13.78 – $33.97 | 4 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | not published | not published | $13.21 – $32.87 | 4 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | not published | not published | $4.71 – $27.82 | 4 |
| Drsg wnd 8.2x9cm sq bilayer theragenesis ster-74sq cm-cost per sq cm HCPCS A2008 | not published | not published | $244.81 – $244.81 | 1 |
| Drsg wnd hyalomatrix 10x10cm -cost per sq cm HCPCS Q4117 | not published | not published | $81.48 – $81.48 | 1 |
| Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 | not published | not published | $54.77 – $142.66 | 4 |
| Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm HCPCS A2007 | not published | not published | $219.27 – $219.27 | 1 |
| Drug admin & hemodynmic meas CPT 93463 | $327.25 | $595.00 | $1,887.00 – $2,334.00 | 2 |
| Drug assay caffeine CPT 80155 | $63.80 | $116.00 | $28.62 – $67.50 | 4 |
| Drug assay posaconazole CPT 80187 | not published | not published | $27.11 – $47.44 | 4 |
| Drug assay rufinamide CPT 80210 | $64.35 | $117.00 | $27.11 – $47.44 | 4 |
| Drug assay vedolizumab CPT 80280 | $466.40 | $848.00 | $38.57 – $67.50 | 4 |
| Drug assay voriconazole CPT 80285 | $44.55 | $81.00 | $27.11 – $47.44 | 4 |
| Drug asy hydroxychloroquine CPT 80220 | not published | not published | $18.64 – $32.62 | 4 |
| Drug of abuse screen urine CPT 80305 | not published | not published | $12.60 – $22.22 | 4 |
| Drug screen quant tiagabine CPT 80199 | not published | not published | $27.11 – $47.44 | 4 |
| Drug test def 15-21 classes HCPCS G0482 | not published | not published | $198.74 – $347.80 | 4 |
| Drug test def 1-7 classes HCPCS G0480 | $188.65 | $343.00 | $114.43 – $200.25 | 4 |
| Drug test def 22+ classes HCPCS G0483 | not published | not published | $246.92 – $432.11 | 4 |
| Drug test def 8-14 classes HCPCS G0481 | not published | not published | $156.59 – $274.03 | 4 |
| Drug test prsmv instrmnt CPT 80306 | $167.75 | $305.00 | $17.14 – $30.00 | 4 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $301.95 | $549.00 | $62.14 – $118.55 | 4 |
| Drvvt confirm - quest CPT 85597 | $32.45 | $59.00 | $17.98 – $36.38 | 4 |
| Dstrj extensive retinopathy CPT 67227 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Dstrj nulyt agt gnclr nrv CPT 64624 | $3,940.75 | $7,165.00 | $3,388.00 – $7,791.00 | 3 |
| Dstr mal les s/n/h/f/g >4.0 CPT 17276 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Dstr mal ls f/e/e/n/l/m2.1-3 CPT 17283 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Dstr mal ls f/e/e/n/l/m3.1-4 CPT 17284 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Dstr mal ls f/e/e/n/l/m>4.0 CPT 17286 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Dstry eye lesn,fdr vssl tech HCPCS G0186 | not published | not published | $2,959.00 – $3,030.00 | 2 |
| Ductogram sgl duct CPT 77053 | $443.30 | $806.00 | $133.79 – $133.79 | 1 |
| Duodenal motility study CPT 91022 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Duplex scan bilateral study 93985 CPT 93985 | $900.90 | $1,638.00 | not published | 0 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $900.90 | $1,638.00 | not published | 0 |
| Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 | $750.20 | $1,364.00 | not published | 0 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $799.15 | $1,453.00 | not published | 0 |
| Durvalumab 50 mg/ml intravenous solution HCPCS J9173 | not published | not published | $90.83 – $228.36 | 5 |
| Dxa bone density axl vrt fx CPT 77085 | not published | not published | $134.97 – $134.97 | 1 |
| Dx bronchoscope/brush 31623 CPT 31623 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Dx bronchoscope/lavage 31624 CPT 31624 | $1,724.25 | $3,135.00 | $3,388.00 – $4,761.00 | 3 |
| Dx bronchoscope/wash 31622 CPT 31622 | $1,881.00 | $3,420.00 | $3,388.00 – $4,761.00 | 3 |
| Dx duod intub w/asp spec 43756 CPT 43756 | not published | not published | $2,654.00 – $4,761.00 | 3 |
| Dx duod intub w/asp specs CPT 43757 | not published | not published | $2,654.00 – $4,761.00 | 3 |
| Dx gastr intub w/asp spec CPT 43754 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Dx gastr intub w/asp specs CPT 43755 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Dx laryngoscopy newborn CPT 31520 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Dx laryngoscopy w/oper scope CPT 31526 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Dynamic cavernosometry CPT 54231 | not published | not published | $2,654.00 – $4,761.00 | 3 |
| Ear and throat examination CPT 92502 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Ear canal biopsy 69105 CPT 69105 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Ear cartilage graft CPT 21235 | not published | not published | $3,579.00 – $4,761.00 | 3 |
| Ear irrigation 69209 CPT 69209 | $143.55 | $261.00 | $1,887.00 – $2,654.00 | 3 |
| Ecallantide injection HCPCS J1290 | not published | not published | $609.68 – $1,533.05 | 5 |
| Ecg 12 lead tracing only CPT 93005 | $171.60 | $312.00 | not published | 0 |
| Ecg external < 48 hours recording CPT 93225 | $462.00 | $840.00 | not published | 0 |
| Ecg external < 48 hours scanning analysis w/report CPT 93226 | $1,201.75 | $2,185.00 | not published | 0 |
| Ecg external > 48 hours up to 7 days recording CPT 93242 | $128.15 | $233.00 | not published | 0 |
| Ecg external >7 days up to 15 days recording CPT 93246 | $128.15 | $233.00 | not published | 0 |
| Echocardiogram (Heart Ultrasound) CPT 93306 | $1,695.10 | $3,082.00 | not published | 0 |
| Echocardiography doppler color flow mapping CPT 93325 | $455.95 | $829.00 | not published | 0 |
| Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler HCPCS C8929 | $2,168.65 | $3,943.00 | not published | 0 |
| Echocardiography transthoracic 2d followup/limited CPT 93308 | $652.30 | $1,186.00 | not published | 0 |
| Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast HCPCS C8924 | $506.00 | $920.00 | not published | 0 |
| Echocardiograpy doppler follow up/limited study CPT 93321 | $179.30 | $326.00 | not published | 0 |
| Echo exam of eye CPT 76516 | not published | not published | $159.92 – $159.92 | 1 |
| Echo exam of eye CPT 76519 | not published | not published | $177.75 – $177.75 | 1 |
| Echo exam of eye CPT 76529 | not published | not published | $156.35 – $156.35 | 1 |
| Echo exam of eye thickness CPT 76514 | not published | not published | $17.34 – $17.34 | 1 |
| Echo exam of fetal heart CPT 76825 | not published | not published | $646.59 – $646.59 | 1 |
| Echo exam of fetal heart CPT 76826 | not published | not published | $409.44 – $409.44 | 1 |
| Echo exam of fetal heart CPT 76827 | $301.40 | $548.00 | $157.54 – $157.54 | 1 |
| Echo exam of fetal heart CPT 76828 | not published | not published | $83.87 – $83.87 | 1 |
| Echo exam uterus 76831- CPT 76831 | $409.20 | $744.00 | $275.17 – $275.17 | 1 |
| Echograp trans r pros study CPT 76873 | not published | not published | $300.12 – $300.12 | 1 |
| Echo guidance radiotherapy CPT 76965 | not published | not published | $79.12 – $79.12 | 1 |
| Echo guide for amniocentesis CPT 76946 | not published | not published | $43.47 – $43.47 | 1 |
| Echo guide for artery repair CPT 76936 | $455.95 | $829.00 | $578.85 – $578.85 | 1 |
| Echo guide for heart biopsy CPT 76932 | not published | not published | $182.67 – $182.67 | 1 |
| Echo guide for transfusion CPT 76941 | not published | not published | $193.37 – $193.37 | 1 |
| Echo guide villus sampling CPT 76945 | $370.15 | $673.00 | $204.77 – $204.77 | 1 |
| Echo stress CPT 93350 | $862.95 | $1,569.00 | not published | 0 |
| Echo tee guidance CPT 93355 | $1,403.60 | $2,552.00 | not published | 0 |
| Echo tee probe placement image acquisition interpretation & report CPT 93312 | $1,158.30 | $2,106.00 | not published | 0 |
| Echo transesophageal CPT 93313 | $983.95 | $1,789.00 | not published | 0 |
| Echo transesophageal intraop CPT 93318 | $843.70 | $1,534.00 | not published | 0 |
| Echo transthoracic CPT 93303 | $1,199.00 | $2,180.00 | not published | 0 |
| Echo transthoracic CPT 93304 | $862.95 | $1,569.00 | not published | 0 |
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.