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 |
|---|---|---|---|---|
| Ghs opcc repair cvp w subq port CPT 36576 | not published | not published | $2,959.00 – $3,388.00 | 3 |
| Ghs ot group caregiver training CPT 97552 | $85.80 | $156.00 | not published | 0 |
| Ghs ot prosthetic training/15 min CPT 97761 | $50.60 | $92.00 | not published | 0 |
| Ghs ot sensory integrative tech/15min CPT 97533 | $52.80 | $96.00 | not published | 0 |
| Ghs ot work hardening-additional hours CPT 97546 | $103.95 | $189.00 | not published | 0 |
| Ghs pacing - transcutaneous CPT 92953 | $981.20 | $1,784.00 | $2,959.00 – $3,030.00 | 2 |
| Ghs paravert facet/nerve cerv ea add bil CPT 64492 | $3,199.35 | $5,817.00 | $1,887.00 – $5,512.00 | 3 |
| Ghs paravert facet/nerve lumb ea add bil CPT 64495 | $3,955.05 | $7,191.00 | $433.00 – $5,512.00 | 4 |
| Ghs path - pap (papanicolau) smear - vagina CPT 88141 | not published | not published | $26.35 – $46.84 | 2 |
| Ghs peritonsillar abscess i andd CPT 42700 | $481.80 | $876.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs phenylketonurid CPT 84030 | not published | not published | $5.50 – $11.12 | 4 |
| Ghs picc line insert < 5 CPT 36568 | $1,809.50 | $3,290.00 | $2,654.00 – $3,030.00 | 3 |
| Ghs plngl fx pm cl CPT 26725 | $526.35 | $957.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs plt ct-manual CPT 85032 | not published | not published | $4.31 – $8.70 | 4 |
| Ghs polysom <6 yrs 4/> parameters CPT 95782 | $3,788.40 | $6,888.00 | not published | 0 |
| Ghs ppd (tb intradermal) CPT 86580 | $34.10 | $62.00 | $10.98 – $22.99 | 2 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | not published | not published | $9.66 – $19.56 | 4 |
| Ghs protein, misc fluid CPT 84160 | $24.75 | $45.00 | $5.61 – $9.82 | 4 |
| Ghs protoporphyrins fract CPT 84202 | $70.95 | $129.00 | $14.35 – $29.03 | 4 |
| Ghs pr without cont pulse ox CPT 94625 | $132.55 | $241.00 | not published | 0 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | not published | not published | $12.25 – $24.78 | 4 |
| Ghs pt - work hardening/int 2hrs CPT 97545 | $221.65 | $403.00 | not published | 0 |
| Ghs quinidine CPT 80194 | not published | not published | $14.60 – $29.56 | 4 |
| Ghs refill of implantable pump CPT 95990 | $505.45 | $919.00 | $1,887.00 – $2,334.00 | 2 |
| Ghs removal intranasal foreign body CPT 30300 | $273.35 | $497.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs removal pharyngeal foreign body CPT 42809 | $561.00 | $1,020.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | not published | not published | $11.77 – $27.81 | 4 |
| Ghs reticulocyte count CPT 85044 | not published | not published | $4.31 – $8.70 | 4 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | not published | not published | $13.91 – $24.34 | 4 |
| Ghs sedimentation rate CPT 85651 | not published | not published | $4.27 – $7.47 | 4 |
| Ghs semen analysis fert CPT 89320 | not published | not published | $12.31 – $24.38 | 4 |
| Ghs semen analysis, post-vas CPT 89300 | not published | not published | $9.84 – $18.07 | 4 |
| Ghs sensitivity (per antimicro) CPT 87184 | $77.55 | $141.00 | $7.48 – $13.96 | 4 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $662.20 | $1,204.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $737.55 | $1,341.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $699.60 | $1,272.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $737.55 | $1,341.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $656.15 | $1,193.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $610.50 | $1,110.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $413.60 | $752.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $737.55 | $1,341.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Ghs sleep study unattended CPT 95800 | $613.80 | $1,116.00 | not published | 0 |
| Ghs somatosensory testing lower extremit CPT 95926 | $793.65 | $1,443.00 | not published | 0 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $1,357.40 | $2,468.00 | not published | 0 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $122.10 | $222.00 | not published | 0 |
| Ghs sphenopalatine ganglion block CPT 64505 | $662.20 | $1,204.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $155.10 | $282.00 | not published | 0 |
| Ghs strapping shoulder - 29240 CPT 29240 | $240.35 | $437.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs st - re-eval for alt comm CPT 92597 | $374.00 | $680.00 | not published | 0 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $1,247.95 | $2,269.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $952.05 | $1,731.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Ghs trypsin (fecal) CPT 84488 | not published | not published | $7.30 – $14.77 | 4 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $526.35 | $957.00 | $1,887.00 – $2,654.00 | 3 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Ghs urine, hydroxproline total CPT 83505 | not published | not published | $24.30 – $49.20 | 4 |
| Ghs urine, porphyrins quant CPT 84120 | $129.25 | $235.00 | $14.71 – $29.77 | 4 |
| Ghs vaginal delivery only CPT 59409 | $4,484.70 | $8,154.00 | $3,388.00 – $7,791.00 | 3 |
| Ghs windowing of cast CPT 29730 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Giardia ag if CPT 87269 | not published | not published | $13.61 – $24.26 | 4 |
| Giardia lamblia antibody CPT 86674 | not published | not published | $14.72 – $29.78 | 4 |
| Gi endoscopic ultrasound CPT 76975 | not published | not published | $200.98 – $200.98 | 1 |
| Gi inhouse confirmation CPT 87045 | $117.70 | $214.00 | $9.44 – $19.09 | 4 |
| Gingivoplasty each quadrant CPT 41872 | not published | not published | $3,388.00 – $16,106.00 | 3 |
| Gi protein loss CPT 78282 | not published | not published | $162.42 – $162.42 | 1 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | $2,550.35 | $4,637.00 | $3,579.00 – $4,761.00 | 2 |
| Gi trc img intral esophagus CPT 91111 | not published | not published | $3,579.00 – $4,761.00 | 2 |
| Gi wireless capsule measure CPT 91112 | not published | not published | $3,579.00 – $4,761.00 | 2 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $101.12 – $176.96 | 4 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $61.52 – $107.66 | 4 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $35.00 – $61.25 | 4 |
| Glassia injection HCPCS J0257 | not published | not published | $5.97 – $15.00 | 5 |
| Glaucoma surgery CPT 66150 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Glaucoma surgery CPT 66155 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Glaucoma surgery CPT 66160 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Glaucoma surgery CPT 66170 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Glucagon 1 mg solution for injection HCPCS J1610 | not published | not published | $199.42 – $501.44 | 5 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | not published | not published | $121.16 – $304.67 | 5 |
| Glucagon plasma - sendout CPT 82943 | $26.95 | $49.00 | $14.29 – $25.01 | 4 |
| Glucagon tolerance panel CPT 80422 | not published | not published | $46.07 – $93.23 | 4 |
| Glucagon tolerance panel CPT 80424 | not published | not published | $50.50 – $102.19 | 4 |
| Glucagon tolerance test CPT 82946 | not published | not published | $15.02 – $31.10 | 4 |
| Glucose 1 hr post dose CPT 82950 | not published | not published | $4.75 – $9.62 | 4 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | not published | not published | $6.05 – $12.24 | 4 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $25.30 | $46.00 | $3.28 – $5.74 | 4 |
| Glucose blood quantitative CPT 82947 | $29.15 | $53.00 | $3.93 – $7.93 | 4 |
| Glucose body fluid CPT 82945 | $44.00 | $80.00 | $3.93 – $7.93 | 4 |
| Glucose monitoring continual min 72hr pt CPT 95249 | $162.25 | $295.00 | not published | 0 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $37.40 | $68.00 | $12.87 – $26.03 | 4 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $37.40 | $68.00 | $3.92 – $7.92 | 4 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | not published | not published | $0.56 – $1.58 | 5 |
| Gold sodium thiomaleate inj HCPCS J1600 | not published | not published | $36.10 – $36.10 | 1 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | not published | not published | $11.41 – $28.69 | 5 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $107.25 | $195.00 | $18.58 – $37.58 | 4 |
| Gonadotropin hormone panel CPT 80426 | not published | not published | $148.41 – $300.31 | 4 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $152.90 | $278.00 | $18.52 – $37.46 | 4 |
| Goniotomy CPT 65820 | not published | not published | $4,428.00 – $7,791.00 | 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.