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 |
|---|---|---|---|---|
| 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 intraop epcar Ultrasound chd i&r CPT 76989 | not published | not published | $99.00 – $99.00 | 1 |
| Dx intraop epicar car Ultrasound chd CPT 76987 | not published | not published | $267.25 – $267.25 | 1 |
| Dx intraop thoracic aorta Ultrasound CPT 76984 | not published | not published | $85.80 – $85.80 | 1 |
| 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 |
| Dx ntrop epcr Ultrasound chd img acq CPT 76988 | not published | not published | $169.27 – $169.27 | 1 |
| 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 guidance radiotherapy HCPCS G6001 | not published | not published | $73.17 – $73.17 | 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 ova aspiration CPT 76948 | not published | not published | $132.59 – $132.59 | 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 |
| 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 |
| Eculizumab injection HCPCS J1300 | not published | not published | $242.70 – $610.27 | 3 |
| Edetate calcium disodium inj HCPCS J0600 | not published | not published | $6,587.41 – $16,563.97 | 5 |
| Edetate disodium per 150 mg HCPCS J3520 | not published | not published | $0.87 – $0.87 | 1 |
| 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 |
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.