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 |
|---|---|---|---|---|
| MRI brain w/dye CPT 70558 | not published | not published | $4,716.28 – $4,716.28 | 1 |
| MRI brain without dye CPT 70557 | not published | not published | $4,448.67 – $4,448.67 | 1 |
| MRI brain without & w/dye CPT 70559 | not published | not published | $4,448.67 – $4,448.67 | 1 |
| MRI breast c- unilateral CPT 77046 | $2,244.00 | $4,080.00 | $595.70 – $595.70 | 1 |
| MRI breast c-+ w/cad uni CPT 77048 | not published | not published | $980.96 – $980.96 | 1 |
| MRI breast without cont bi CPT 77047 | $4,191.00 | $7,620.00 | $592.09 – $592.09 | 1 |
| MRI breast w IV cont bi CPT 77049 | not published | not published | $976.14 – $976.14 | 1 |
| MRI cardiac morph & func wo IV cont CPT 75557 | $2,105.40 | $3,828.00 | $669.65 – $669.65 | 1 |
| MRI cardiac morph & func wwo IV cont CPT 75561 | $2,305.60 | $4,192.00 | $976.91 – $976.91 | 1 |
| MRI cardiac morph & func wwo IV cont w/stress img CPT 75563 | not published | not published | $1,177.73 – $1,177.73 | 1 |
| MRI chest without contrast CPT 71550 | $1,980.00 | $3,600.00 | $1,132.57 – $1,132.57 | 1 |
| MRI chest without & w/contrast CPT 71552 | $2,183.50 | $3,970.00 | $1,546.74 – $1,546.74 | 1 |
| MRI chest w IV cont CPT 71551 | $2,079.00 | $3,780.00 | $1,234.75 – $1,234.75 | 1 |
| MRI fetal ea addl gestation CPT 74713 | not published | not published | $470.04 – $470.04 | 1 |
| MRI fetal sngl/1st gestation CPT 74712 | not published | not published | $1,096.90 – $1,096.90 | 1 |
| MRI guid ndl plc s&i CPT 77021 | $1,080.75 | $1,965.00 | $1,091.46 – $1,091.46 | 1 |
| MRI guid parenchymal tiss ablation CPT 77022 | not published | not published | $1,564.47 – $1,564.47 | 1 |
| MRI loex nonjt w IV cont CPT 73719 | not published | not published | $1,071.95 – $1,071.95 | 1 |
| MRI lower extremity other than joint without contrast (both sides) CPT 73718 | $2,227.50 | $4,050.00 | $986.41 – $986.41 | 1 |
| MRI lower extremity other than joint without & w/contrast (both sides) CPT 73720 | $2,450.80 | $4,456.00 | $1,310.78 – $1,310.78 | 1 |
| MRI orbit/face/neck without contrast CPT 70540 | $1,658.80 | $3,016.00 | $967.41 – $967.41 | 1 |
| MRI orbit/face/neck without & w/contrast CPT 70543 | $1,829.30 | $3,326.00 | $1,276.33 – $1,276.33 | 1 |
| MRI orbit fac&nck w IV cont CPT 70542 | $1,741.85 | $3,167.00 | $1,064.84 – $1,064.84 | 1 |
| MRI tmj CPT 70336 | $2,137.30 | $3,886.00 | $818.88 – $818.88 | 1 |
| MRI upper extremity other than joint without contrast (both sides) CPT 73218 | $2,194.50 | $3,990.00 | $986.41 – $986.41 | 1 |
| MRI upper extremity other than joint without & w/contrast (both sides) CPT 73220 | $2,419.45 | $4,399.00 | $1,301.27 – $1,301.27 | 1 |
| MRI upper extremity w/dye CPT 73219 | $2,303.95 | $4,189.00 | $1,071.95 – $1,071.95 | 1 |
| MRI w/cont, breast, bi HCPCS C8906 | $4,401.10 | $8,002.00 | not published | 0 |
| MRI w/cont, breast, uni HCPCS C8903 | $2,356.20 | $4,284.00 | not published | 0 |
| MRI without fol w/cont, breast HCPCS C8908 | $4,620.55 | $8,401.00 | not published | 0 |
| MRI without fol w/cont, brst, un HCPCS C8905 | $2,474.45 | $4,499.00 | not published | 0 |
| Mr safety determination physician/other qhp CPT 76016 | not published | not published | $206.90 – $206.90 | 1 |
| Mr safety implant elec prepj CPT 76018 | not published | not published | $326.01 – $326.01 | 1 |
| Mr safety implant&/fb assmt clin staff ea add 30 CPT 76015 | not published | not published | $146.84 – $146.84 | 1 |
| Mr safety implt pos&/immoblj CPT 76019 | not published | not published | $423.15 – $423.15 | 1 |
| Mr sfty implt&/fb asmt stf 1 CPT 76014 | not published | not published | $30.50 – $30.50 | 1 |
| Mr sfty med physics xm cstmz CPT 76017 | not published | not published | $636.66 – $636.66 | 1 |
| Mr spectroscopy CPT 76390 | $2,237.95 | $4,069.00 | $1,250.67 – $1,250.67 | 1 |
| Msh2 gene dup/delete variant CPT 81297 | not published | not published | $213.30 – $373.28 | 4 |
| Msh2 gene full seq CPT 81295 | not published | not published | $225.02 – $667.98 | 4 |
| Msh2 gene known variants CPT 81296 | not published | not published | $192.13 – $591.03 | 4 |
| Msh6 gene dup/delete variant CPT 81300 | not published | not published | $238.00 – $416.50 | 4 |
| Msh6 gene full seq CPT 81298 | not published | not published | $426.92 – $1,123.24 | 4 |
| Msh6 gene known variants CPT 81299 | not published | not published | $239.17 – $539.00 | 4 |
| Mt bone graft microvasc CPT 20957 | not published | not published | $6,779.00 – $18,364.00 | 3 |
| Mthfr gene analy common variants CPT 81291 | $509.30 | $926.00 | $65.34 – $114.35 | 4 |
| M.tuberculo dna dir probe CPT 87555 | not published | not published | $26.88 – $47.04 | 4 |
| M.tuberculo dna quant CPT 87557 | not published | not published | $42.84 – $86.68 | 4 |
| Mucin synovial fluid CPT 83872 | not published | not published | $5.86 – $11.86 | 4 |
| Mucopolysaccharides CPT 83864 | not published | not published | $28.50 – $49.88 | 4 |
| Mucormycosis antibody CPT 86732 | not published | not published | $15.00 – $26.70 | 4 |
| Multi family grp psychotherapy CPT 90849 | $102.30 | $186.00 | not published | 0 |
| Multiple sleep latency test CPT 95805 | $2,283.05 | $4,151.00 | not published | 0 |
| Mumps antibody igg CPT 86735 | $114.95 | $209.00 | $13.05 – $26.40 | 4 |
| Muscle-skin graft arm CPT 15736 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Muscle-skin graft leg CPT 15738 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Muscle-skin graft trunk CPT 15734 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Muscle test cran nerv unilat CPT 95867 | $180.95 | $329.00 | not published | 0 |
| Muscle test larynx CPT 95865 | $188.65 | $343.00 | not published | 0 |
| Muscle transfers CPT 23397 | not published | not published | $6,779.00 – $16,106.00 | 3 |
| Muscle transfer shoulder/arm CPT 23395 | not published | not published | $6,779.00 – $16,106.00 | 3 |
| Musc myoq/fscq flp h&n pedcl CPT 15733 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Musc/tdn transfer upr a/e 1 CPT 24301 | not published | not published | $6,779.00 – $8,770.00 | 3 |
| Mycobacteria dna amp probe CPT 87551 | $107.80 | $196.00 | $48.24 – $84.42 | 4 |
| Mycobacteria dna dir probe CPT 87550 | not published | not published | $20.05 – $40.58 | 4 |
| Mycobacteria dna quant CPT 87552 | not published | not published | $42.84 – $86.68 | 4 |
| Mycophenolate mofetil 250 mg capsule HCPCS J7517 | not published | not published | $0.16 – $0.41 | 5 |
| Mycophenolic acid HCPCS J7518 | not published | not published | $0.42 – $1.30 | 5 |
| Mycoplasma antibody igm CPT 86738 | $79.20 | $144.00 | $13.24 – $26.80 | 4 |
| Myd88 gene p.leu265pro vrnt CPT 81305 | $770.00 | $1,400.00 | $175.40 – $306.95 | 4 |
| Myelogphy 2/> spine regions CPT 72270 | not published | not published | $197.94 – $197.94 | 1 |
| Myelography l-s spine CPT 72265 | not published | not published | $165.86 – $165.86 | 1 |
| Myelography neck spine CPT 72240 | not published | not published | $171.80 – $171.80 | 1 |
| Myelography thoracic spine CPT 72255 | not published | not published | $168.24 – $168.24 | 1 |
| Myelography via inj w/s&i 2+ regions CPT 62305 | $3,054.15 | $5,553.00 | $2,654.00 – $3,030.00 | 3 |
| Myelography via inj w/s&i cervical CPT 62302 | $2,109.80 | $3,836.00 | $2,654.00 – $3,030.00 | 3 |
| Myelography via inj w/s&i lumbosacral CPT 62304 | $2,352.35 | $4,277.00 | $2,654.00 – $3,030.00 | 3 |
| Myelography via inj w/s&i thoracic CPT 62303 | $2,272.05 | $4,131.00 | $2,654.00 – $3,030.00 | 3 |
| Myeloperoxidase ab multi step qualitative/semiquantitative CPT 83516 | $161.70 | $294.00 | $11.53 – $23.34 | 4 |
| Myocardial resection 33542 CPT 33542 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Myocrd img pet 1std rst/strs CPT 78491 | $3,722.95 | $6,769.00 | $1,285.53 – $1,285.53 | 1 |
| Myocrd img pet 1 std w/ct CPT 78429 | not published | not published | $1,372.43 – $1,372.43 | 1 |
| Myocrd img pet 2rtracer CPT 78432 | not published | not published | $2,023.53 – $2,023.53 | 1 |
| Myocrd img pet 2rtracer CT CPT 78433 | not published | not published | $2,228.24 – $2,228.24 | 1 |
| Myocrd img pet mlt rst&strs CPT 78492 | not published | not published | $1,533.24 – $1,533.24 | 1 |
| Myocrd img pet rst&strs CT CPT 78431 | not published | not published | $1,911.35 – $1,911.35 | 1 |
| Myocrd img pet rst/strs w/ct CPT 78430 | not published | not published | $1,644.58 – $1,644.58 | 1 |
| Myomectomy abdom complex CPT 58146 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Myomectomy abdom method CPT 58140 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Myomectomy vag method CPT 58145 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Myringoplasty CPT 69620 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Nabilone oral HCPCS J8650 | not published | not published | $41.38 – $41.38 | 1 |
| Nafcillin 2 gram solution for injection HCPCS J2290 | not published | not published | $0.11 – $0.76 | 2 |
| Nalbuphine 10 mg/ml injection solution HCPCS J2300 | not published | not published | $3.39 – $9.34 | 5 |
| Naloxone 0.4 mg/ml injection (wrapper) HCPCS J2312 | not published | not published | $0.13 – $0.13 | 1 |
| Naltrexone, depot form HCPCS J2315 | not published | not published | $4.46 – $11.22 | 5 |
| Nandrolone decanoate 50 mg HCPCS J2320 | not published | not published | $10.56 – $10.56 | 1 |
| Nasal endoscopy dx uni/bi separate proc CPT 31231 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Nasal endoscopy with removal of nasal foreign body CPT 30999 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Nasal/sinus endoscopy surg CPT 31287 | not published | not published | $4,956.00 – $8,770.00 | 4 |
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.