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 |
|---|---|---|---|---|
| Octreotide,microspheres ER 20 mg intramuscular susp, extended release HCPCS J2353 | not published | not published | $225.05 – $594.51 | 5 |
| Ocular photodynamic ther CPT 67221 | not published | not published | $2,654.00 – $3,030.00 | 3 |
| Ocular reconst transplant CPT 65780 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Ocular reconst transplant CPT 65781 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Ocular reconst transplant CPT 65782 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Ofatumumab 20 mg/ml intravenous solution (wrapper) HCPCS J9302 | not published | not published | $169.42 – $169.42 | 1 |
| Olanzapine 10 mg intramuscular solution HCPCS J2359 | not published | not published | $0.81 – $2.05 | 5 |
| Olanzapine long-acting inj HCPCS J2358 | not published | not published | $3.15 – $7.95 | 5 |
| Omalizumab 150 mg/ml subcutaneous syringe (wrapper) HCPCS J2357 | not published | not published | $40.88 – $102.80 | 5 |
| Omental flap extra-abdom 49904 CPT 49904 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Omental flap intra-abdom 49905 CPT 49905 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Onc breast mrna 12 genes CPT 81522 | not published | not published | $3,873.00 – $6,777.75 | 4 |
| Onc breast mrna 58 genes CPT 81520 | not published | not published | $2,510.21 – $4,603.50 | 4 |
| Onc breast mrna 70 genes CPT 81521 | not published | not published | $3,873.00 – $6,777.75 | 4 |
| Onc brst mrna 11 genes CPT 81518 | not published | not published | $3,873.00 – $6,777.75 | 4 |
| Onc brst mrna 70 cnt 31 gene CPT 81523 | not published | not published | $3,873.00 – $6,777.75 | 4 |
| Onc cutan mlnma mrna 31 gene CPT 81529 | not published | not published | $7,193.00 – $12,587.75 | 4 |
| Oncology colon mrna CPT 81525 | not published | not published | $3,116.00 – $5,453.00 | 4 |
| Oncology colorectal scr CPT 81528 | not published | not published | $508.87 – $890.52 | 4 |
| Oncology gynecologic CPT 81535 | not published | not published | $523.03 – $1,014.06 | 4 |
| Oncology gynecologic CPT 81536 | not published | not published | $177.56 – $310.73 | 4 |
| Oncology lung CPT 81538 | not published | not published | $2,871.00 – $5,024.25 | 4 |
| Oncology prostate prob score CPT 81539 | not published | not published | $760.00 – $1,330.00 | 4 |
| Oncology tissue of origin CPT 81504 | not published | not published | $520.00 – $910.00 | 4 |
| Oncology tum unknown origin CPT 81540 | not published | not published | $3,750.00 – $6,562.50 | 4 |
| Onco (ovar) five proteins CPT 81503 | not published | not published | $897.00 – $1,569.75 | 4 |
| Onco (ovar) two proteins CPT 81500 | not published | not published | $260.50 – $455.88 | 4 |
| Oncoprotein dcp CPT 83951 | $102.30 | $186.00 | $64.41 – $130.33 | 4 |
| Oncoprotein her-2/neu CPT 83950 | not published | not published | $64.41 – $130.33 | 4 |
| Onc prostate 3 genes CPT 81551 | not published | not published | $2,030.00 – $3,552.50 | 4 |
| Onc prostate mrna 22 cnt gen CPT 81542 | not published | not published | $3,873.00 – $6,777.75 | 3 |
| Onc prostate mrna 46 genes CPT 81541 | not published | not published | $3,873.00 – $6,777.75 | 4 |
| Onc thyr mrna 10,196 gen alg CPT 81546 | not published | not published | $3,600.00 – $6,300.00 | 4 |
| Onc uveal mlnma mrna 15 gene CPT 81552 | not published | not published | $7,776.00 – $13,608.00 | 4 |
| Ondansetron 8 mg disintegrating tablet HCPCS Q0162 | not published | not published | $0.01 – $0.03 | 4 |
| Ondansetron hcl (pf) 2 mg/ml injection (wrapper) HCPCS J2405 | not published | not published | $0.09 – $0.25 | 5 |
| Oocyte identification CPT 89254 | not published | not published | $143.50 – $143.50 | 1 |
| Oophorectomy partial or total 58943 CPT 58943 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Open ablate liver tumor cryo CPT 47381 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Open ablate liver tumor rf CPT 47380 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Open aortic tube prosth repair 34830 CPT 34830 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Open aortofemor prosth repr CPT 34832 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Open aortoiliac prosth repr 34831 CPT 34831 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Open bx/exc inguinofem nodes CPT 38531 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Open bx of lung pleura 32098 CPT 32098 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Open cor endarterect w cabg/ea ves 33572 CPT 33572 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Open nasoethmoid fx with fixj CPT 21339 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Open nasoethmoid fx without fixj CPT 21338 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Open periprosthetic breast capsule 19370 CPT 19370 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Open skull for drainage 61312 CPT 61312 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Open tenotomy tendon flexor foot single or multiple 28230 CPT 28230 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Open thrombectomy of av fistula without revision 36831 CPT 36831 | not published | not published | $4,428.00 – $18,364.00 | 3 |
| Open tx compl front sinus fx CPT 21344 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Open tx iliac spine uni/bil HCPCS G0412 | not published | not published | $3,735.00 – $18,364.00 | 3 |
| Open tx nose fx w/skele fixj CPT 21330 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Open tx nose & septal fx CPT 21335 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Open tx post pelvic fxcture HCPCS G0415 | not published | not published | $3,735.00 – $18,364.00 | 3 |
| Open tx rib 1-3 fx w/fix 21811 CPT 21811 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Open tx rib 4-6 fx w/fix 21812 CPT 21812 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Open tx rib 7+ fx w/fix 21813 CPT 21813 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Open tx/sternum fracture 21825 CPT 21825 | not published | not published | $3,735.00 – $18,364.00 | 3 |
| Open wedge/bx lung infiltr CPT 32096 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Open wedge bx lung nodule 32097 CPT 32097 | not published | not published | $5,257.00 – $5,257.00 | 1 |
| Ophthalmic endoscope add-on CPT 66990 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Ophth Ultrasound b & quant a CPT 76510 | not published | not published | $272.79 – $272.79 | 1 |
| Oph Ultrasound dx ant sgm Ultrasound uni/bi CPT 76513 | not published | not published | $197.94 – $197.94 | 1 |
| Oph Ultrasound dx quan a-scan only CPT 76511 | $336.60 | $612.00 | $161.12 – $161.12 | 1 |
| Opn abltj 1/> rnl mas crysrg CPT 50250 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Opn ax/subcla art expos CPT 34715 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Opn exc/dst ntra-abd CPT 49189 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Opn exc/dst ntra-abd 10.1-20 CPT 49188 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Opn exc/dstr ntra-abd >30 cm CPT 49190 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Opn exc/dstr ntra-abd 5.1-10 CPT 49187 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Opn exc/dstr ntra-abd 5 cm/< CPT 49186 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Opn fem art expos cndt crtj 34714 CPT 34714 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Opn ilac art expos cndt crtj CPT 34833 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Opn impltj crnl nrv nea&pg CPT 64568 | not published | not published | $8,923.00 – $54,996.00 | 3 |
| Opn impltj nea neuromuscular CPT 64580 | not published | not published | $8,923.00 – $27,583.00 | 3 |
| Opn impltj nea perph nerve CPT 64575 | not published | not published | $8,923.00 – $27,583.00 | 3 |
| Opn impltj nea sacral nerve CPT 64581 | not published | not published | $7,609.00 – $27,583.00 | 3 |
| Opn mpltj hpglsl nstm ary pg CPT 64582 | not published | not published | $8,923.00 – $44,873.00 | 3 |
| Opn tx complx malar fx CPT 21365 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Opn tx complx malar w/grft CPT 21366 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Opn tx depress front sinus fx 21343 CPT 21343 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Opn tx dprsd zygomatic arch CPT 21356 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Opn tx nasomax fx multple CPT 21347 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Opn tx nasomax fx w/fixj CPT 21346 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Opn tx nasomax fx w/graft CPT 21348 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Opn tx orbit fx combined CPT 21387 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Opn tx orbit fx periorbital CPT 21386 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Opn tx orbit fx transantral CPT 21385 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Opn tx orbit fx w/bone grft CPT 21408 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Opn tx orbit fx w/implant CPT 21407 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Opn tx orbit fx without impl 21406 CPT 21406 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Opn tx orbit periorbtl implt CPT 21390 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Opn tx orbit periorbt w/grft CPT 21395 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Opps service,sched team conf HCPCS G0175 | $221.10 | $402.00 | not published | 0 |
| Oprelvekin injection HCPCS J2355 | not published | not published | $651.65 – $651.65 | 1 |
| Optical endomicroscpy interp CPT 88375 | not published | not published | $51.25 – $72.31 | 2 |
| Optx acrclv dslc aq/chrn grf CPT 23552 | not published | not published | $6,779.00 – $18,364.00 | 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.