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 |
|---|---|---|---|---|
| Lengthen radius & ulna CPT 25393 | not published | not published | $3,735.00 – $16,106.00 | 3 |
| Lens, intraocular (new tech) HCPCS C1780 | $740.54 | $1,346.44 | not published | 0 |
| Lens iol 23.0 d 1.5 cyl eyhance toric HCPCS V2787 | $810.60 | $1,473.82 | not published | 0 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $342.63 | $622.97 | not published | 0 |
| Lens iol ant chamb 10.5 HCPCS V2630 | $144.56 | $262.84 | not published | 0 |
| Lepirudin HCPCS J1945 | not published | not published | $395.42 – $395.42 | 1 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | not published | not published | $3.86 – $11.32 | 5 |
| Leukacyte transfusion CPT 86950 | not published | not published | $104.21 – $143.50 | 2 |
| Leukocyte phagocytosis CPT 86344 | not published | not published | $10.39 – $18.18 | 4 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | not published | not published | $189.52 – $492.20 | 5 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | not published | not published | $1,804.66 – $4,537.81 | 5 |
| Leuprolide acetate injeciton HCPCS J9218 | not published | not published | $9.65 – $24.26 | 3 |
| Leuprolide depot cipla 7.5mg HCPCS J1954 | not published | not published | $242.81 – $640.55 | 5 |
| Leuprolide inj, camcevi, 1mg HCPCS J1952 | not published | not published | $57.62 – $152.21 | 5 |
| Levalbuterol comp unit HCPCS J7615 | not published | not published | $5.28 – $5.28 | 1 |
| Levalbuterol non-comp con HCPCS J7612 | not published | not published | $0.31 – $0.79 | 5 |
| Levalbuterol non-comp unit HCPCS J7614 | not published | not published | $0.09 – $0.25 | 5 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | not published | not published | $0.06 – $0.13 | 5 |
| Levetiracetam therapeutic drug level CPT 80177 | $151.80 | $276.00 | $13.25 – $26.82 | 4 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | not published | not published | $1.13 – $5.15 | 5 |
| Levonorgestrel implant sys HCPCS J7306 | not published | not published | $1,023.31 – $1,023.31 | 1 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | not published | not published | $5.84 – $14.67 | 5 |
| L hrt cath chd nm/abn nt cnj CPT 93595 | not published | not published | $3,735.00 – $16,106.00 | 3 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | not published | not published | $0.17 – $0.17 | 1 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | not published | not published | $0.01 – $0.03 | 4 |
| Lidocaine therapeutic drug level CPT 80176 | $24.20 | $44.00 | $14.69 – $29.71 | 4 |
| Ligate esophagus veins CPT 43400 | not published | not published | $4,428.00 – $18,364.00 | 3 |
| Ligate leg veins open CPT 37761 | not published | not published | $2,959.00 – $3,388.00 | 3 |
| Ligate leg veins radical 37760 CPT 37760 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Ligate oviduct(s) add-on 58611 CPT 58611 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Ligate/staple esophagus CPT 43405 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Ligate/strip long leg vein CPT 37722 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Ligate/strip short leg vein CPT 37718 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Ligate/transect fallopian tubes 58600 CPT 58600 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Ligation common iliac vein CPT 37660 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Ligation/divis of long saph vein 37700 CPT 37700 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Ligation external carotid artery 37600 CPT 37600 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Ligation internal/common carotid artery 37605 CPT 37605 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Ligation internal jugular vein 37565 CPT 37565 | not published | not published | $2,959.00 – $3,388.00 | 3 |
| Ligation major artery chest CPT 37616 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Ligation/major artery/extremity 37618 CPT 37618 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Ligation major artery neck CPT 37615 | $5,715.60 | $10,392.00 | $2,959.00 – $3,388.00 | 3 |
| Ligation nasal sinus artery CPT 30915 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Ligation of abdomen artery 37617 CPT 37617 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Ligation of femoral vein CPT 37650 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Ligation of inf vena cava CPT 37619 | not published | not published | $4,428.00 – $18,364.00 | 3 |
| Ligation of neck artery CPT 37606 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Ligation of salivary duct CPT 42665 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Ligation of shunt CPT 49428 | not published | not published | $3,579.00 – $4,761.00 | 3 |
| Ligation upper jaw artery CPT 30920 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Ligation vericose vein cluster(s) 1 leg CPT 37785 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Lig/band angioaccess av fistula CPT 37607 | $2,615.80 | $4,756.00 | $3,735.00 – $8,770.00 | 3 |
| Lig&div&compl strpg saph vn CPT 37735 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Liletta, 52 mg HCPCS J7297 | not published | not published | $2,899.00 – $2,899.00 | 1 |
| Limb nerve surgery add-on CPT 64783 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Limited autopsy CPT 88036 | not published | not published | $103.58 – $164.68 | 2 |
| Limited autopsy CPT 88037 | not published | not published | $92.03 – $146.38 | 2 |
| Lincomycin injection HCPCS J2010 | not published | not published | $6.86 – $18.32 | 5 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | not published | not published | $3.23 – $8.12 | 5 |
| Lipase CPT 83690 | $66.00 | $120.00 | $6.89 – $13.94 | 4 |
| Lip exc/transverse wedge/w closure 40510 CPT 40510 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Lipoprotein blood high res frac & quant CPT 83701 | not published | not published | $33.86 – $59.26 | 4 |
| Lipoprotein blood quant CPT 83704 | $267.85 | $487.00 | $34.19 – $63.85 | 4 |
| Lipoprotein direct measurement hdl CPT 83718 | $67.10 | $122.00 | $8.19 – $16.57 | 4 |
| Lipoprotein direct measurement ldl CPT 83721 | $77.55 | $141.00 | $10.50 – $19.32 | 4 |
| Lipoprtn dir meas sd ldl chl CPT 83722 | not published | not published | $34.19 – $59.83 | 4 |
| Lip surgery procedure CPT 40799 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Lisocabtagene mara car pos t HCPCS Q2054 | not published | not published | $568,086.52 – $1,406,133.05 | 4 |
| Listeria monocytogenes CPT 86723 | not published | not published | $11.77 – $23.08 | 4 |
| Lith ion batt cid,non-earlvl HCPCS L8623 | $24,235.34 | $44,064.25 | not published | 0 |
| Lithium therapeutic drug level CPT 80178 | $70.95 | $129.00 | $6.61 – $13.38 | 4 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | $2,472.25 | $4,495.00 | not published | 0 |
| Litt icr 1 traj 1 smpl les CPT 61736 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Litt icr mlt trj mlt/cplx ls CPT 61737 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Liver abs/cyst dr opn 1-2 stge CPT 47010 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Liver ds alys 3 bmrk srm alg CPT 81517 | not published | not published | $176.19 – $308.33 | 4 |
| Liver elastography 91200 CPT 91200 | $322.30 | $586.00 | $50.62 – $50.62 | 1 |
| Liver Function Test CPT 80076 | $93.50 | $170.00 | $8.17 – $16.54 | 4 |
| Liver hem/re-expl wnd/remove pack 47362 CPT 47362 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Liver imaging CPT 78201 | not published | not published | $574.81 – $574.81 | 1 |
| Liver imag w/vasclr flow CPT 78202 | $2,256.65 | $4,103.00 | $614.02 – $614.02 | 1 |
| Liver/spleen imag static only CPT 78215 | $1,936.00 | $3,520.00 | $589.06 – $589.06 | 1 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $1,936.00 | $3,520.00 | $338.37 – $338.37 | 1 |
| Lmtd oph exam general anes CPT 92019 | not published | not published | $7,529.00 – $7,791.00 | 2 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | not published | not published | $1.02 – $3.42 | 4 |
| Loncastuximab tesirine-lpyl 10 mg intravenous solution HCPCS J9359 | not published | not published | $229.67 – $577.50 | 5 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | not published | not published | $1.46 – $3.68 | 5 |
| Low back disk surgery CPT 63030 | not published | not published | $6,779.00 – $18,364.00 | 3 |
| Low cost skin substitute app HCPCS C5271 | $1,442.10 | $2,622.00 | $1,887.00 – $2,334.00 | 2 |
| Low cost skin substitute app HCPCS C5273 | $2,985.95 | $5,429.00 | $3,579.00 – $4,761.00 | 2 |
| Low cost skin substitute app HCPCS C5275 | $1,372.80 | $2,496.00 | $1,887.00 – $2,334.00 | 2 |
| Low cost skin substitute app HCPCS C5277 | $3,015.10 | $5,482.00 | $1,887.00 – $2,334.00 | 2 |
| Low cost skin substitute app HCPCS C5272 | $309.10 | $562.00 | $1,887.00 – $2,334.00 | 2 |
| Low cost skin substitute app HCPCS C5274 | $994.40 | $1,808.00 | $1,887.00 – $2,334.00 | 2 |
| Low cost skin substitute app HCPCS C5276 | $322.85 | $587.00 | $1,887.00 – $2,334.00 | 2 |
| Low cost skin substitute app HCPCS C5278 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $1,648.90 | $2,998.00 | $686.28 – $686.28 | 1 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $1,570.25 | $2,855.00 | $554.38 – $554.38 | 1 |
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.