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 |
|---|---|---|---|---|
| Assay alkaline phosphatase CPT 84078 | not published | not published | $8.26 – $14.77 | 4 |
| Assay blood catecholamines CPT 82383 | not published | not published | $29.08 – $50.89 | 4 |
| Assay chondroitin sulfate CPT 82485 | not published | not published | $20.65 – $41.78 | 4 |
| Assay dir meas fr estradiol CPT 82681 | not published | not published | $27.94 – $48.90 | 4 |
| Assay duodenal fluid trypsin CPT 84485 | not published | not published | $7.20 – $15.20 | 4 |
| Assay free hydroxyproline CPT 83500 | not published | not published | $22.65 – $45.83 | 4 |
| Assay malate dehydrogenase CPT 83775 | not published | not published | $7.37 – $14.92 | 4 |
| Assay myeloperoxidase CPT 83876 | not published | not published | $50.86 – $89.01 | 4 |
| Assay of adp & amp CPT 82030 | not published | not published | $25.80 – $52.20 | 4 |
| Assay of androsterone CPT 82160 | not published | not published | $25.55 – $50.59 | 4 |
| Assay of blood lipoprotein CPT 83719 | not published | not published | $12.75 – $23.53 | 4 |
| Assay of bradykinin CPT 82286 | not published | not published | $5.16 – $13.94 | 4 |
| Assay of breath ethanol CPT 82075 | not published | not published | $24.38 – $52.50 | 4 |
| Assay of cathepsin-d CPT 82387 | not published | not published | $18.06 – $34.63 | 4 |
| Assay of chloramphenicol CPT 82415 | not published | not published | $12.67 – $25.64 | 4 |
| Assay of corticosterone CPT 82528 | not published | not published | $22.52 – $45.56 | 4 |
| Assay of digoxin free CPT 80163 | $20.90 | $38.00 | $13.28 – $26.87 | 4 |
| Assay of endocrine hormone CPT 84235 | not published | not published | $71.23 – $124.65 | 4 |
| Assay of estrogen CPT 84233 | not published | not published | $87.88 – $153.79 | 4 |
| Assay of etiocholanolone CPT 82696 | not published | not published | $26.24 – $47.71 | 4 |
| Assay of feces for trypsin CPT 84490 | not published | not published | $9.93 – $17.38 | 4 |
| Assay of feces porphyrins CPT 84126 | not published | not published | $39.11 – $68.44 | 4 |
| Assay of feces/urobilinogen CPT 84577 | not published | not published | $16.80 – $29.40 | 4 |
| Assay of fluoride CPT 82735 | not published | not published | $18.54 – $37.50 | 4 |
| Assay of galactose CPT 82760 | not published | not published | $11.20 – $22.66 | 4 |
| Assay of gdh enzyme CPT 82965 | not published | not published | $13.15 – $23.01 | 4 |
| Assay of glucosidase CPT 82963 | not published | not published | $21.48 – $43.48 | 4 |
| Assay of glutathione CPT 82978 | not published | not published | $15.45 – $28.85 | 4 |
| Assay of haptoglobins CPT 83012 | not published | not published | $26.89 – $47.06 | 4 |
| Assay of idh enzyme CPT 83570 | not published | not published | $8.85 – $17.89 | 4 |
| Assay of interleukin-6 (il-6) CPT 83529 | $124.30 | $226.00 | $17.27 – $30.22 | 4 |
| Assay of intrinsic factor CPT 83528 | not published | not published | $19.82 – $34.69 | 4 |
| Assay of lap enzyme CPT 83670 | not published | not published | $9.81 – $18.54 | 4 |
| Assay of leflunomide CPT 80193 | not published | not published | $38.57 – $67.50 | 4 |
| Assay of lrh hormone CPT 83727 | not published | not published | $17.19 – $34.80 | 4 |
| Assay of methemalbumin CPT 83857 | not published | not published | $10.74 – $21.74 | 4 |
| Assay of neonatal thyroxine CPT 84437 | not published | not published | $6.47 – $13.08 | 4 |
| Assay of osteocalcin CPT 83937 | not published | not published | $29.85 – $60.42 | 4 |
| Assay of phenylketones CPT 84035 | not published | not published | $3.98 – $7.42 | 4 |
| Assay of pregnanediol CPT 84135 | not published | not published | $21.27 – $38.71 | 4 |
| Assay of pregnanetriol CPT 84138 | not published | not published | $21.05 – $38.30 | 4 |
| Assay of procainamide w/metab CPT 80192 | not published | not published | $16.75 – $33.90 | 4 |
| Assay of progesterone CPT 84234 | not published | not published | $64.88 – $131.29 | 4 |
| Assay of prostaglandin CPT 84150 | not published | not published | $41.77 – $73.10 | 4 |
| Assay of PSA complexed CPT 84152 | not published | not published | $18.39 – $37.22 | 4 |
| Assay of quinine CPT 84228 | not published | not published | $11.63 – $23.53 | 4 |
| Assay of rbc pg6d enzyme CPT 84085 | not published | not published | $9.44 – $16.52 | 4 |
| Assay of salicylate CPT 80179 | $30.80 | $56.00 | $18.64 – $32.62 | 4 |
| Assay of semen fructose CPT 82757 | not published | not published | $12.60 – $30.35 | 4 |
| Assay of sialic acid CPT 84275 | not published | not published | $13.44 – $27.18 | 4 |
| Assay of silica CPT 84285 | not published | not published | $25.21 – $47.64 | 4 |
| Assay of somatostatin CPT 84307 | not published | not published | $17.96 – $31.99 | 4 |
| Assay of thiocyanate CPT 84430 | not published | not published | $11.63 – $23.53 | 4 |
| Assay of troponin qual CPT 84512 | not published | not published | $10.09 – $17.66 | 4 |
| Assay of tyrosine CPT 84510 | not published | not published | $10.63 – $21.05 | 4 |
| Assay of urine sulfate CPT 84392 | not published | not published | $5.49 – $9.62 | 4 |
| Assay of urine urobilinogen CPT 84580 | not published | not published | $9.55 – $16.71 | 4 |
| Assay of urine urobilinogen CPT 84583 | not published | not published | $6.05 – $10.59 | 4 |
| Assay phosphatidylglycerol CPT 84081 | not published | not published | $16.52 – $33.43 | 4 |
| Assay phosphohexose enzymes CPT 84087 | not published | not published | $10.73 – $20.90 | 4 |
| Assay rbc glutathione CPT 82979 | not published | not published | $9.44 – $16.52 | 4 |
| Assay toxin or antitoxin CPT 87230 | $44.00 | $80.00 | $19.74 – $39.97 | 4 |
| Assess care plan pt w/cog impair 99483 CPT 99483 | $424.05 | $771.00 | not published | 0 |
| Assess cyst contrast inject CPT 49424 | $337.15 | $613.00 | $1,887.00 – $5,512.00 | 3 |
| Assessment leukocyte fecal qualitative/semiquantitative CPT 89055 | not published | not published | $4.27 – $8.64 | 4 |
| Assist-bilat spinal disk surgery add-on 63035 CPT 63035 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Assist oocyte fertilization CPT 89280 | not published | not published | $628.20 – $628.20 | 1 |
| Assist oocyte fertilization CPT 89281 | not published | not published | $143.50 – $143.50 | 1 |
| Ast/sgot CPT 84450 | $21.45 | $39.00 | $5.18 – $10.48 | 4 |
| Atezolizumab 60 mg/ml intravenous solution (wrapper) HCPCS J9022 | not published | not published | $95.52 – $240.17 | 5 |
| Athrectomy fem/pop/unilateral 37225 CPT 37225 | $13,229.15 | $24,053.00 | $7,609.00 – $27,583.00 | 3 |
| Athrectomy tib/pero/unilat/ini ves 37229 CPT 37229 | $12,584.00 | $22,880.00 | $8,923.00 – $27,583.00 | 3 |
| Atomic absorption CPT 82190 | not published | not published | $15.90 – $27.83 | 4 |
| Atropine 0.1 mg/ml injection syringe HCPCS J0461 | not published | not published | $0.11 – $0.30 | 5 |
| Attach bladder/urethra comp 51841 CPT 51841 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Attach bladder/urethra simple 51840 CPT 51840 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Attach ocular implant CPT 65140 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Augmentation cheek bone CPT 21270 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Augmentation lower jaw bone CPT 21125 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Augmentation lower jaw bone CPT 21127 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Augmentation of facial bones CPT 21208 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Augumentation percutaneous vertebral inc cavity creation ea addl thoracic/lumbar vertebral body CPT 22515 | $6,790.30 | $12,346.00 | $1,887.00 – $5,512.00 | 3 |
| Augumentation percutaneous vertebral including cavity creation 1 vertebral body thoracic CPT 22513 | $7,004.80 | $12,736.00 | $6,779.00 – $18,364.00 | 3 |
| Autgrft implnt knee w/scope CPT 29866 | not published | not published | $6,779.00 – $18,364.00 | 3 |
| Autochondrocyte implant knee CPT 27412 | not published | not published | $6,779.00 – $18,364.00 | 3 |
| Autoimmune rheumatoid arthr anl 12 mrk ia CPT 81490 | not published | not published | $840.65 – $1,471.14 | 4 |
| Autologous blood op salvage CPT 86891 | not published | not published | $192.13 – $628.20 | 2 |
| Autologous blood process CPT 86890 | not published | not published | $136.22 – $143.50 | 2 |
| Automated diff wbc count CPT 85004 | not published | not published | $6.47 – $13.08 | 4 |
| Avelumab 20 mg/ml intravenous solution HCPCS J9023 | not published | not published | $104.97 – $263.95 | 5 |
| Av fistula revision CPT 36833 | $4,413.20 | $8,024.00 | $4,428.00 – $18,364.00 | 3 |
| Av fuse uppr arm basilic CPT 36819 | not published | not published | $4,428.00 – $18,364.00 | 3 |
| Av fuse uppr arm cephalic CPT 36818 | not published | not published | $4,428.00 – $18,364.00 | 3 |
| Av fusion direct any site CPT 36821 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Av fusion/forearm vein 36820 CPT 36820 | not published | not published | $4,428.00 – $18,364.00 | 3 |
| Avul nail plate addl CPT 11732 | $244.20 | $444.00 | $1,887.00 – $5,512.00 | 3 |
| Avulsion nail plate partial/complete simple single nail plate CPT 11730 | $275.55 | $501.00 | $1,887.00 – $2,654.00 | 3 |
| Axicabtagene ciloleucel car+ HCPCS Q2041 | not published | not published | $553,124.80 – $1,332,710.45 | 4 |
| Axillary lymphadenect/superficial 38740 CPT 38740 | not published | not published | $5,257.00 – $18,364.00 | 3 |
| Azacitidine injection HCPCS J9025 | not published | not published | $0.31 – $0.79 | 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.