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 |
|---|---|---|---|---|
| Ecmo/ecls daily mgmt artery 33949 CPT 33949 | $1,023.55 | $1,861.00 | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls daily mgmt-venous 33948 CPT 33948 | $1,023.55 | $1,861.00 | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls initiation artery 33947 CPT 33947 | $1,728.65 | $3,143.00 | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls initiation venous 33946 CPT 33946 | $1,532.30 | $2,786.00 | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls insj cent cannula 0-5yrs 33955 CPT 33955 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls insj cent cannula 6yrs&older 33956 CPT 33956 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls insj prph cannula 0-5yrs opn 33953 CPT 33953 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls insj prph cannula 0-5yrs perq 33951 CPT 33951 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls insj prph cannula 6yrs&older opn 33954 CPT 33954 | $2,645.50 | $4,810.00 | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls insj prph cannula 6yrs&older perq 33952 CPT 33952 | $1,630.75 | $2,965.00 | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls remove cent cannula 0-5yrs 33985 CPT 33985 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls remove cent cannula 6yrs&older 33986 CPT 33986 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls remove perph cannula 0-5yrs opn 33969 CPT 33969 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls remove perph cannula 0-5yrs perq 33965 CPT 33965 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls remove prph cannula 6yrs&older open 33984 CPT 33984 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls remove prph cannula 6yrs&older perq 33966 CPT 33966 | $374.55 | $681.00 | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls repos cent cnula 6yrs&older 33964 CPT 33964 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls repos cent/perph cnula 0-5yrs 33963 CPT 33963 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls repos perph cnula 0-5yrs opn 33959 CPT 33959 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls repos perph cnula 0-5yrs perq 33957 CPT 33957 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls repos perph cnula 6yrs&older opn 33962 CPT 33962 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Ecmo/ecls repos perph cnula 6yrs&older perq 33958 CPT 33958 | $182.60 | $332.00 | $3,388.00 – $3,388.00 | 1 |
| E coli 0157 ag ia CPT 87335 | not published | not published | $12.66 – $24.26 | 4 |
| Ecp ciliary body destruction CPT 66711 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Eculizumab 300 mg/30 ml intravenous solution HCPCS J1299 | not published | not published | $49.29 – $85.06 | 2 |
| Edetate calcium disodium inj HCPCS J0600 | not published | not published | $6,587.41 – $16,563.97 | 5 |
| Eeg 41-60 minutes 95812-26 CPT 95812 | $956.45 | $1,739.00 | not published | 0 |
| Eeg/cerebral death evaluation only 95824 -26 CPT 95824 | $757.35 | $1,377.00 | not published | 0 |
| Eeg during surgery CPT 95955 | $429.00 | $780.00 | not published | 0 |
| Eeg monitor/record/awake/drowsy 95816 CPT 95816 | $661.65 | $1,203.00 | not published | 0 |
| Eeg over 1 hour 95813 - 26 CPT 95813 | $851.40 | $1,548.00 | not published | 0 |
| Eeg/record in coma or sleep only 95822 CPT 95822 | $326.70 | $594.00 | not published | 0 |
| Eeg recording awake and asleep CPT 95819 | $778.80 | $1,416.00 | not published | 0 |
| E equine encephalitis igg CPT 86652 | $34.10 | $62.00 | $11.77 – $23.08 | 4 |
| Efgartigimod alfa-fcab 20 mg/ml intravenous solution HCPCS J9332 | not published | not published | $35.14 – $88.34 | 5 |
| Egd balloon dil esoph30 mm/> CPT 43233 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Egd control bleeding any CPT 43255 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Egd dilate stricture CPT 43245 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Egd endo mucosal resection CPT 43254 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Egd endoscopic stent place CPT 43266 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Egd esophagogastrc fndoplsty CPT 43210 | not published | not published | $7,609.00 – $8,770.00 | 3 |
| Egd flx trnsorl dplmnt balo CPT 43290 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Egd flx trnsorl rmvl balo CPT 43291 | not published | not published | $2,654.00 – $4,761.00 | 3 |
| Egd guide wire insertion CPT 43248 | not published | not published | $2,654.00 – $4,761.00 | 3 |
| Egd injection varices CPT 43243 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Egd/insert intraluminal tube/cath 43241 CPT 43241 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Egd lesion ablation CPT 43270 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Egd optical endomicroscopy CPT 43252 | not published | not published | $3,579.00 – $4,761.00 | 3 |
| Egd remove foreign body CPT 43247 | not published | not published | $2,654.00 – $4,761.00 | 3 |
| Egd remove lesion snare CPT 43251 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Egd/remov tum/polyp/hot bx forcep 43250 CPT 43250 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Egd Ultrasound exam duodenum/jejunum CPT 43259 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Egd Ultrasound fine needle bx/aspir CPT 43238 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Egd Ultrasound fine needle bx/aspir CPT 43242 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Egd Ultrasound transmural injxn/mark CPT 43253 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Egd varices ligation CPT 43244 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Egd w/thrml txmnt gerd CPT 43257 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Egd w/transmural drain cyst CPT 43240 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Egfr gene com variants CPT 81235 | $1,037.30 | $1,886.00 | $324.58 – $568.02 | 4 |
| Ehrlicha chaffeensis amp prb CPT 87484 | $64.90 | $118.00 | $35.09 – $61.41 | 4 |
| EKG tracing for initial prev HCPCS G0404 | $170.50 | $310.00 | not published | 0 |
| Elbow arthroscopy CPT 29830 | not published | not published | $3,735.00 – $18,364.00 | 3 |
| Elbow arthroscopy/surgery CPT 29834 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Elbow arthroscopy/surgery CPT 29835 | not published | not published | $3,735.00 – $18,364.00 | 3 |
| Elbow arthroscopy/surgery CPT 29836 | not published | not published | $6,779.00 – $18,364.00 | 3 |
| Elbow arthroscopy/surgery CPT 29837 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Elbow arthroscopy/surgery CPT 29838 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Elec analys infus pump w/reprog 62368 CPT 62368 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Elect analysis of infusion pump 62367 CPT 62367 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Elect anlys sp inf pmp w/reprg&fill 62369 CPT 62369 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Electrd sq emblem s-icd HCPCS C1896 | $6,651.56 | $12,093.75 | not published | 0 |
| Electrical bone stim 20974 CPT 20974 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Electrode stimulation brain CPT 95961 | $497.75 | $905.00 | not published | 0 |
| Electroejaculation CPT 55870 | not published | not published | $2,654.00 – $3,030.00 | 3 |
| Electrogastrography CPT 91132 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Electrogastrography w/test CPT 91133 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Electrolyte panel CPT 80051 | $50.60 | $92.00 | $7.01 – $14.17 | 4 |
| Electron microscopy diagnostic CPT 88348 | $699.05 | $1,271.00 | $380.68 – $628.20 | 2 |
| Electrophysiologic study CPT 93624 | not published | not published | $17,314.00 – $18,364.00 | 2 |
| Electrophysiology evaluation CPT 93619 | $9,067.30 | $16,486.00 | $17,314.00 – $18,364.00 | 2 |
| Electrophysiology evaluation CPT 93620 | $9,067.30 | $16,486.00 | $17,314.00 – $18,364.00 | 2 |
| Electrophysiology evaluation CPT 93621 | $3,620.10 | $6,582.00 | $1,887.00 – $2,334.00 | 2 |
| Electrophysiology evaluation CPT 93622 | $3,620.10 | $6,582.00 | $1,887.00 – $2,334.00 | 2 |
| Electrophysiology evaluation CPT 93641 | $961.95 | $1,749.00 | $1,887.00 – $2,334.00 | 2 |
| Electrophysiology evaluation CPT 93642 | $1,559.80 | $2,836.00 | $3,579.00 – $4,761.00 | 2 |
| Electrophysiology evaluation CPT 93644 | $1,553.75 | $2,825.00 | $1,887.00 – $2,334.00 | 2 |
| Electrophys map 3d add-on CPT 93613 | $3,119.05 | $5,671.00 | $1,887.00 – $2,334.00 | 2 |
| Elosulfase alfa, injection HCPCS J1322 | not published | not published | $318.24 – $800.20 | 5 |
| Elotuzumab 300 mg intravenous solution HCPCS J9176 | not published | not published | $8.36 – $21.02 | 5 |
| Elranatamab-bcmm 40 mg/ml subcutaneous solution HCPCS J1323 | not published | not published | $192.34 – $483.65 | 5 |
| Embedded ip cath exit-site 49436 CPT 49436 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Embolization s&i CPT 75894 | $874.50 | $1,590.00 | $2,922.55 – $2,922.55 | 1 |
| Embo or occlude vascular arterial s&i CPT 37242 | $8,031.65 | $14,603.00 | $7,609.00 – $27,583.00 | 3 |
| Embo or occlude vascular hemorrhage s&i CPT 37244 | $9,557.90 | $17,378.00 | $7,609.00 – $27,583.00 | 3 |
| Embo or occlude vascular tumor/organ/infarct s&i CPT 37243 | $9,191.05 | $16,711.00 | $7,609.00 – $27,583.00 | 3 |
| Embo or occlude vascular venous s&i CPT 37241 | $9,325.25 | $16,955.00 | $7,609.00 – $27,583.00 | 3 |
| Embryo hatching CPT 89253 | not published | not published | $143.50 – $143.50 | 1 |
| Embryo transfer intrauterine CPT 58974 | not published | not published | $2,654.00 – $3,030.00 | 3 |
| Emb/throm/fempop/aor/ilia/leg inc 34201 CPT 34201 | $3,838.45 | $6,979.00 | $4,428.00 – $18,364.00 | 3 |
| Emb/throm/pop-tib-pero art/leg inc 34203 CPT 34203 | not published | not published | $4,428.00 – $18,364.00 | 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.