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 |
|---|---|---|---|---|
| Implant ureter in bowel CPT 50800 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Implant ureth bulk agent HCPCS L8606 | $540.31 | $982.39 | not published | 0 |
| Impl neurostim electr perc CPT 63650 | not published | not published | $7,609.00 – $18,364.00 | 3 |
| Implnt bio implnt for soft tiss reinforcement 15777 CPT 15777 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Implnt spinl canal catheter 62350 CPT 62350 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Impl oi implt sk tc esp<100 CPT 69716 | not published | not published | $7,609.00 – $18,364.00 | 3 |
| Impl oi implt sk tc esp>=100 CPT 69729 | not published | not published | $7,609.00 – $18,364.00 | 3 |
| Impl oi implt skull perq esp CPT 69714 | not published | not published | $7,609.00 – $27,583.00 | 3 |
| Impl/rplcmt gstr nstim eltrd CPT 43881 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Implt brain chemotx add-on 61517 CPT 61517 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Impltj ntrstrml crnl rng seg CPT 65785 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Impltj tot rplcmt hrt sys CPT 33927 | not published | not published | $8,923.00 – $8,923.00 | 1 |
| Implt neurostim elctr each HCPCS L8680 | $4,637.51 | $8,431.84 | not published | 0 |
| Imported lipodox inj HCPCS Q2049 | not published | not published | $1,439.82 – $1,439.82 | 1 |
| Impres&prep auricular prosth CPT 21086 | not published | not published | $3,388.00 – $16,106.00 | 3 |
| Impres&prep def obt prosth CPT 21080 | not published | not published | $3,388.00 – $16,106.00 | 3 |
| Impres&prep facial prosth CPT 21088 | not published | not published | $3,388.00 – $16,106.00 | 3 |
| Impres&prep intrm obt prosth CPT 21079 | not published | not published | $3,388.00 – $16,106.00 | 3 |
| Impres&prep mndbl res prosth CPT 21081 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Impres&prep nasal prosth CPT 21087 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Impres&prep oral surg splint CPT 21085 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Impres&prep orbital prosth CPT 21077 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Impres&prep paltl aug prosth CPT 21082 | not published | not published | $3,388.00 – $16,106.00 | 3 |
| Impres&prep paltl lft prosth CPT 21083 | not published | not published | $3,388.00 – $16,106.00 | 3 |
| Impres&prep sp aid prosth CPT 21084 | not published | not published | $3,388.00 – $16,106.00 | 3 |
| Impres&prep surg obt prosth CPT 21076 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Imuglucerase injection HCPCS J1786 | not published | not published | $46.97 – $118.11 | 5 |
| In-111 autologous plt stdy dx HCPCS A9571 | not published | not published | $11,632.29 – $11,632.29 | 1 |
| In-111 autol wbc diag per dose HCPCS A9570 | $983.95 | $1,789.00 | $2,807.95 – $2,807.95 | 1 |
| In-111 capromab pendet HCPCS A9507 | not published | not published | $3,576.24 – $3,576.24 | 1 |
| In-111 ibritumomab tiux dx HCPCS A9542 | not published | not published | $2,172.60 – $2,172.60 | 1 |
| In-111 oxyquinolin per 0.5 mci HCPCS A9547 | not published | not published | $2,103.52 – $2,103.52 | 1 |
| In-111 pentetate dtpa / 0.5 mci HCPCS A9548 | $636.90 | $1,158.00 | $1,947.38 – $1,947.38 | 1 |
| In-111 pentetreotide HCPCS A9572 | not published | not published | $5,212.53 – $5,212.53 | 1 |
| In-111 satumomab pend HCPCS A4642 | not published | not published | $4,419.90 – $4,419.90 | 1 |
| Inactivated je vacc im CPT 90738 | not published | not published | $832.29 – $832.29 | 1 |
| Inc deep opng b1 crtx thorax CPT 21510 | not published | not published | $3,735.00 – $16,106.00 | 3 |
| Inc dp bone crtx f/arm&/wrst CPT 25035 | not published | not published | $6,779.00 – $7,791.00 | 3 |
| Inc dp opn b1 crtx hum/elbw CPT 23935 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Incis 1 vertebral seg cerv CPT 22210 | not published | not published | $3,735.00 – $18,364.00 | 3 |
| Incis 1 vertebral seg lumbar CPT 22214 | not published | not published | $3,735.00 – $18,364.00 | 3 |
| Incis 1 vertebral seg thorac CPT 22212 | not published | not published | $3,735.00 – $18,364.00 | 3 |
| Incis addl spine segment CPT 22216 | not published | not published | $1,887.00 – $3,735.00 | 3 |
| Incise bile duct sphincter CPT 47460 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Incise diaphragm nerve CPT 64746 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Incise/drain eyelid lining CPT 68020 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Incise flexor carpi radialis CPT 25001 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Incise hand/finger tendon CPT 26460 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Incise hip/thigh nerve CPT 64763 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Incise hip/thigh nerve CPT 64766 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Incise inner ear CPT 69801 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Incise inner ear nerve CPT 69915 | not published | not published | $3,388.00 – $16,106.00 | 3 |
| Incise inner ear nerve CPT 69950 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Incise inner eye adhesions CPT 65860 | not published | not published | $2,654.00 – $3,030.00 | 3 |
| Incise inner eye adhesions CPT 65865 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Incise inner eye adhesions CPT 65870 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Incise inner eye adhesions CPT 65875 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Incise inner eye adhesions CPT 65880 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Incise inner eye strands CPT 67030 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Incise nerve back of head CPT 64744 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Incise perq finger tendon 26060 CPT 26060 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Incise skull/brain surgery CPT 61720 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Incise skull/brain surgery CPT 61735 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Incise skull for treatment CPT 61770 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Incise skull repair CPT 62121 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Incise skull/sutures CPT 61556 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Incise skull/sutures CPT 61557 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Incise sperm duct pouch CPT 55600 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Incise spinal cord tract(s) CPT 63170 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Incise spine accessory nerve CPT 63191 | not published | not published | $6,779.00 – $27,583.00 | 3 |
| Incise spine nrv >2 segmnts CPT 63190 | not published | not published | $6,779.00 – $27,583.00 | 3 |
| Incise spine nrv half segmnt CPT 63185 | not published | not published | $6,779.00 – $27,583.00 | 3 |
| Incise tear duct opening 68440 CPT 68440 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Incise tendon(s) & muscle(s) CPT 23406 | $4,824.05 | $8,771.00 | $3,735.00 – $8,770.00 | 3 |
| Incise thigh tendon & fascia CPT 27305 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Incise & treat bladder CPT 51030 | not published | not published | $7,529.00 – $7,791.00 | 2 |
| Incise wrist/forearm tendon CPT 25290 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Incision anal septum infant CPT 46070 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Incision & drainage hematoma/seroma/fluid collection CPT 10140 | $3,395.15 | $6,173.00 | $3,388.00 – $4,761.00 | 3 |
| Incision & drainage open of deep abscess (subfascial) pos CPT 22010 | not published | not published | $3,388.00 – $18,364.00 | 3 |
| Incision/fixation of femur CPT 27165 | not published | not published | $3,735.00 – $18,364.00 | 3 |
| Incision of achilles tendon CPT 27605 | $5,201.90 | $9,458.00 | $3,388.00 – $7,791.00 | 3 |
| Incision of achilles tendon CPT 27606 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Incision of anal sphincter CPT 46080 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Incision of ankle bone CPT 28302 | not published | not published | $6,779.00 – $7,791.00 | 3 |
| Incision of bile duct CPT 47425 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Incision of bile duct 47420 CPT 47420 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Incision of brain tissue CPT 61541 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Incision of brain tissue CPT 61567 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Incision of breast lesion CPT 19020 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Incision of brow nerve CPT 64732 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Incision of burn scab initi CPT 16035 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Incision of cheek nerve CPT 64734 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Incision of chin nerve CPT 64736 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Incision of eardrum CPT 69420 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Incision of eardrum CPT 69421 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Incision of esophagus CPT 43020 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Incision of eye CPT 65850 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Incision of eye CPT 66172 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Incision of eyelid CPT 67710 | not published | not published | $3,388.00 – $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.