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 |
|---|---|---|---|---|
| Mayo mgrm acetylcholine receptor binding antibody CPT 86041 | $22.00 | $40.00 | $18.40 – $32.20 | 4 |
| Mayo microsomal antibody liver-kidney CPT 86376 | $97.90 | $178.00 | $14.55 – $29.42 | 4 |
| Mayo mitotane (lysodren) therapeutic drug level CPT 80299 | $166.65 | $303.00 | $18.64 – $32.62 | 4 |
| Mayo molecular pathology procedure level 2 apoe genotype CPT 81401 | $756.80 | $1,376.00 | $137.00 – $239.75 | 4 |
| Mayo mpl sequence analysis exon 10 CPT 81339 | not published | not published | $185.20 – $324.10 | 4 |
| Mayo muramidase CPT 85549 | not published | not published | $18.75 – $37.94 | 4 |
| Mayo muscle-specific kinase (musk) antibody CPT 86366 | $22.00 | $40.00 | $18.40 – $32.20 | 4 |
| Mayo mycophenolic acid therapeutic drug level CPT 80180 | $134.20 | $244.00 | $18.05 – $36.52 | 4 |
| Mayo myoglobin CPT 83874 | $112.75 | $205.00 | $12.92 – $26.14 | 4 |
| Mayo nickel CPT 83885 | not published | not published | $24.51 – $49.58 | 4 |
| Mayo opatu opiates definitive assay >=1 CPT 80361 | $107.80 | $196.00 | $35.06 – $35.06 | 1 |
| Mayo opatu opioid/analogs definitive assay 1 or 2 CPT 80362 | $194.15 | $353.00 | $35.06 – $35.06 | 1 |
| Mayo opatu oxycodone definitive assay CPT 80365 | $117.15 | $213.00 | $35.06 – $35.06 | 1 |
| Mayo organic acid methylmalonic single quantitative CPT 83921 | $123.75 | $225.00 | $21.21 – $37.12 | 4 |
| Mayo organic acids qualitative each specimen CPT 83919 | $147.95 | $269.00 | $16.45 – $33.30 | 4 |
| Mayo oxalate 24 hour urine CPT 83945 | $25.85 | $47.00 | $14.45 – $26.03 | 4 |
| Mayo pancreatic elastase fecal qualitative or semi quantitative CPT 82656 | not published | not published | $11.53 – $23.34 | 4 |
| Mayo parvs parvovirus b19 antibody igg CPT 86747 | $111.10 | $202.00 | $15.03 – $30.43 | 4 |
| Mayo paval fluorescent antibody screen agna type 1 CPT 86255 | $129.80 | $236.00 | $12.05 – $24.38 | 4 |
| Mayo pborb infectious agent nucleic acid amplified probe borrelia burgdorferi (lyme) CPT 87476 | $379.50 | $690.00 | $35.09 – $71.00 | 4 |
| Mayo phospholipid neutralization hexagonal lupus anticoagulant CPT 85598 | $92.95 | $169.00 | $17.98 – $36.38 | 4 |
| Mayo pntft phenytoin free therapeutic drug level CPT 80186 | $94.60 | $172.00 | $13.76 – $24.08 | 4 |
| Mayo pqnu porphobilinogen urine quantitative 24 hour urine CPT 84110 | $15.40 | $28.00 | $8.44 – $17.09 | 4 |
| Mayo pregnenolone CPT 84140 | not published | not published | $20.67 – $41.84 | 4 |
| Mayo prmb primidone therapeutic drug level CPT 80188 | $106.15 | $193.00 | $16.59 – $33.59 | 4 |
| Mayo proinsulin CPT 84206 | $156.75 | $285.00 | $26.69 – $46.71 | 4 |
| Mayo psaft prostate specific antigen free CPT 84154 | $100.10 | $182.00 | $18.39 – $37.22 | 4 |
| Mayo radioimmunoassay procollagen i intact n-terminal antibody quantitative CPT 83519 | $117.15 | $213.00 | $18.40 – $32.20 | 4 |
| Mayo rbcme osmotic fragility rbc incubated CPT 85557 | not published | not published | $13.36 – $27.04 | 4 |
| Mayo receptor assay transferrin soluble CPT 84238 | not published | not published | $36.57 – $73.99 | 4 |
| Mayo renin CPT 84244 | $189.75 | $345.00 | $21.99 – $44.51 | 4 |
| Mayo repu protein electrophoresis urine CPT 84166 | $112.20 | $204.00 | $17.83 – $36.08 | 4 |
| Mayo selenium CPT 84255 | $47.30 | $86.00 | $25.53 – $51.67 | 4 |
| Mayo semb semen analysis volume/count/motility/differential strict morphologic criteria CPT 89322 | not published | not published | $15.50 – $31.37 | 4 |
| Mayo serotonin CPT 84260 | $247.50 | $450.00 | $30.98 – $62.69 | 4 |
| Mayo sfgp rickettsia rickettsii antibody igg CPT 86757 | $95.70 | $174.00 | $19.35 – $39.17 | 4 |
| Mayo sirolimus therapeutic drug level CPT 80195 | $25.85 | $47.00 | $13.73 – $27.79 | 4 |
| Mayo syphilis test non-treponemal antibody qualitative vdrl CPT 86592 | $35.20 | $64.00 | $4.27 – $8.64 | 4 |
| Mayo tau phosphorylated 217 each CPT 84393 | $235.58 | $428.33 | not published | 0 |
| Mayo tcgr analysis gene rearrangement trb@ abnormal clonal population(s) amplification CPT 81340 | not published | not published | $208.92 – $422.75 | 4 |
| Mayo tgrp testosterone free CPT 84402 | $198.55 | $361.00 | $25.47 – $51.54 | 4 |
| Mayo tgrp testosterone total CPT 84403 | $223.30 | $406.00 | $25.81 – $50.99 | 4 |
| Mayo thiopurine s-methyltransferase CPT 84433 | $93.50 | $170.00 | $22.17 – $38.80 | 4 |
| Mayo thyroglobulin CPT 84432 | $77.55 | $141.00 | $16.06 – $32.51 | 4 |
| Mayo ticks anaplasma phagocytophilum antibody igg CPT 86666 | $111.10 | $202.00 | $10.18 – $17.82 | 4 |
| Mayo ticks babesia microti antibody igg CPT 86753 | $39.05 | $71.00 | $11.77 – $21.68 | 4 |
| Mayo tramadol definitive assay w metabolite quantitative urine CPT 80373 | $188.65 | $343.00 | $35.06 – $35.06 | 1 |
| Mayo ttfb testosterone bioavailable direct CPT 84410 | $92.40 | $168.00 | $51.28 – $107.76 | 4 |
| Mayo tulab francisella tularensis antibody igg CPT 86668 | $23.65 | $43.00 | $14.16 – $24.78 | 4 |
| Mayo valpg valproic acid free therapeutic drug level CPT 80165 | $26.40 | $48.00 | $13.54 – $27.43 | 4 |
| Mayo vasoactive intestinal peptide CPT 84586 | $105.05 | $191.00 | $25.80 – $61.83 | 4 |
| Mayo vitamin b-2 (riboflavin) CPT 84252 | $36.85 | $67.00 | $20.24 – $40.94 | 4 |
| Mayo vitamin b3 (niacin) CPT 84591 | $30.80 | $56.00 | $17.06 – $29.86 | 4 |
| Mayo vitamin k CPT 84597 | $121.55 | $221.00 | $13.72 – $27.77 | 4 |
| Mayo zonisamide therapeutic drug level CPT 80203 | $150.70 | $274.00 | $13.25 – $26.82 | 4 |
| Maze/extensive/w/card/pulm bypass 33259 CPT 33259 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Mcoln1 gene CPT 81290 | not published | not published | $39.31 – $68.79 | 4 |
| Mcp joint arthroscopy dx CPT 29900 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Mcp joint arthroscopy surg CPT 29901 | not published | not published | $3,735.00 – $18,364.00 | 3 |
| Mcp joint arthroscopysurg 29902 CPT 29902 | not published | not published | $3,388.00 – $8,770.00 | 3 |
| Mdfc flap w/prsrv vasc pedcl CPT 15730 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Measure kidney pressure CPT 50396 | not published | not published | $2,654.00 – $3,030.00 | 3 |
| Measurement post void urine by ultrasound CPT 51798 | $101.20 | $184.00 | $1,887.00 – $5,512.00 | 3 |
| Measure ureter pressure CPT 50686 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Mecasermin injection HCPCS J2170 | not published | not published | $459.76 – $459.76 | 1 |
| Mechlorethamine hcl inj HCPCS J9230 | not published | not published | $345.21 – $345.21 | 1 |
| #mec-opiates CPT 80356 | $105.60 | $192.00 | $35.06 – $35.06 | 1 |
| Mecp2 gene dup/delet variant CPT 81304 | not published | not published | $150.00 – $262.50 | 4 |
| Mecp2 gene full seq CPT 81302 | not published | not published | $527.87 – $923.77 | 4 |
| Mecp2 gene known variant CPT 81303 | not published | not published | $120.00 – $210.00 | 4 |
| Medial canthopexy CPT 21280 | not published | not published | $3,388.00 – $16,106.00 | 3 |
| Mediastinoscpy w/lmph nod bx CPT 39402 | not published | not published | $5,257.00 – $16,106.00 | 3 |
| Mediastinoscpy w/medstnl bx 39401 CPT 39401 | not published | not published | $5,257.00 – $16,106.00 | 3 |
| Med physic dos eval rad exps CPT 76145 | not published | not published | $2,890.42 – $2,890.42 | 1 |
| Medroxyprogesterone 150 mg/ml im injection (wrapper) HCPCS J1050 | not published | not published | $1.37 – $1.37 | 1 |
| Melphalan oral 2 mg HCPCS J8600 | not published | not published | $35.13 – $35.13 | 1 |
| Membrane affinity fresh amniotic 2.5x2.5cm -cost per sq cm HCPCS Q4159 | not published | not published | $289.22 – $716.97 | 4 |
| Membrane amnioband 2x2cm -cost per sq cm HCPCS Q4151 | not published | not published | $150.13 – $390.46 | 4 |
| Membrane amnio clarix 4x3cm 1k -cost per sq cm HCPCS Q4155 | not published | not published | $28.94 – $78.19 | 4 |
| Membrane amniotic barrier 4x4cm-q4163-cost per sq cm HCPCS Q4163 | not published | not published | $200.40 – $495.99 | 4 |
| Membrane collgn porcine maci w/autologous cult chondrocytes HCPCS J7330 | not published | not published | $198,192.56 – $198,192.56 | 1 |
| Membrane placenta tiss biodfence g3 2x2cm-4sqcm-q4116-cost per sq cm HCPCS Q4140 | not published | not published | $185.81 – $467.76 | 4 |
| Membrane placenta tiss enverse sheet 2x3cm-cost per sq cm HCPCS Q4258 | not published | not published | $79.00 – $199.88 | 4 |
| Memoderm/derma/tranz/integup HCPCS Q4126 | not published | not published | $69.63 – $162.10 | 4 |
| Menacwy-tt menb-fhbp vacc im CPT 90623 | not published | not published | $751.41 – $751.41 | 1 |
| Meniscal trnspl knee w/scpe CPT 29868 | not published | not published | $6,779.00 – $18,364.00 | 3 |
| Meperidine (pf) 25 mg/ml injection (wrapper) HCPCS J2175 | not published | not published | $7.54 – $29.82 | 5 |
| Meperidine/promethazine inj HCPCS J2180 | not published | not published | $20.26 – $20.26 | 1 |
| Mepolizumab 100 mg/ml subcutaneous auto-injector HCPCS J2182 | not published | not published | $33.23 – $83.56 | 5 |
| Meropenem 1 gram intravenous solution HCPCS J2185 | not published | not published | $0.42 – $1.06 | 5 |
| Mesh/prosth/ pelvic floor rpr/vag 57267 CPT 57267 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Mesna 100 mg/ml intravenous solution HCPCS J9209 | not published | not published | $1.50 – $4.31 | 5 |
| Metabolic Blood Panel (Basic) CPT 80048 | $100.10 | $182.00 | $8.46 – $17.11 | 4 |
| Metabolic Blood Panel (Comprehensive) CPT 80053 | $132.55 | $241.00 | $10.56 – $21.40 | 4 |
| Metabolic panel ionized ca CPT 80047 | not published | not published | $13.73 – $24.03 | 4 |
| Methacholine chloride 0.0625 mg/ml nebulization soln HCPCS J7674 | not published | not published | $1.74 – $4.39 | 5 |
| Methadone injection HCPCS J1230 | not published | not published | $22.37 – $56.25 | 5 |
| Methocarbamol ivpb 250 mg in 50 ml ns - cnr (headpain) HCPCS J2800 | not published | not published | $7.00 – $17.89 | 5 |
| Methotrexate sodium 2.5 mg tablet HCPCS J8610 | not published | not published | $0.19 – $0.50 | 5 |
| Methotrexate sodium (pf) 1 gram solution for injection HCPCS J9260 | not published | not published | $2.84 – $9.17 | 5 |
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.