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 |
|---|---|---|---|---|
| Biopsy of upper nose/throat CPT 42804 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Biopsy of urethra CPT 53200 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Biopsy of wrist joint CPT 25100 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Biopsy oocyte polar body CPT 89291 | not published | not published | $143.50 – $143.50 | 1 |
| Biopsy oocyte polar body <=5 CPT 89290 | not published | not published | $143.50 – $143.50 | 1 |
| Biopsy/removal lymph nodes CPT 38525 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Biopsy/removal lymph nodes 38520 CPT 38520 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Biopsy renal percutaneous trocar/needle (both sides) CPT 50200 | $1,399.20 | $2,544.00 | $3,388.00 – $4,761.00 | 3 |
| Biopsy roof of mouth CPT 42100 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Biopsy skin incisional single lesion CPT 11106 | $1,074.15 | $1,953.00 | $2,654.00 – $3,030.00 | 3 |
| Biopsy/soft tissue/neck or thorax 21550 CPT 21550 | $1,424.50 | $2,590.00 | $3,388.00 – $4,761.00 | 3 |
| Biopsy thigh soft tissues CPT 27324 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Biopsy tongue anterior two-thirds CPT 41100 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Biopsy vaginal mucosa xtnsv CPT 57105 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Biopsy vestibule of mouth 40808 CPT 40808 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Biopsy vrt bdy open lmbr/crv CPT 20251 | not published | not published | $6,779.00 – $8,770.00 | 3 |
| Biopsy vrt bdy open thoracic CPT 20250 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Biospy of bladder CPT 53899 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Biotinidase - quest CPT 82261 | not published | not published | $16.87 – $29.52 | 4 |
| Bivalirudin HCPCS J0583 | not published | not published | $0.17 – $0.43 | 5 |
| Bladder irrigate/lavage/instill 51700 CPT 51700 | $627.55 | $1,141.00 | $1,887.00 – $2,654.00 | 3 |
| Bld exchange truj oth thn nb CPT 36455 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Bld prd mix CPT 86965 | not published | not published | $44.72 – $143.50 | 2 |
| Bld push tfuj 2 yr/< CPT 36440 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Bleomycin 15 unit solution for injection HCPCS J9040 | not published | not published | $22.64 – $56.93 | 5 |
| Blepharoplasty lower 15820 CPT 15820 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Blepharoplasty upper 15822 CPT 15822 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Blepharoplasty upper eyelid 15823 CPT 15823 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Blepharp lwr eyelid fat pad CPT 15821 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Blinatumomab 35 mcg intravenous solution HCPCS J9039 | not published | not published | $165.12 – $415.21 | 5 |
| Blind cor sinus reducer impl HCPCS C9783 | not published | not published | $7,609.00 – $27,583.00 | 3 |
| Blind interatrial shunt ide HCPCS C9758 | not published | not published | $43,285.00 – $44,873.00 | 2 |
| Blind myocar trpl bon marrow HCPCS C9782 | not published | not published | $7,609.00 – $44,873.00 | 3 |
| Blind/nonblind trans atrial HCPCS C9792 | not published | not published | $7,609.00 – $27,583.00 | 2 |
| Blm gene CPT 81209 | not published | not published | $39.31 – $68.79 | 4 |
| Bln 1.2 mono emrg 15x1.2 HCPCS C1725 | $476.66 | $866.66 | not published | 0 |
| Bln 30frx10mmx12cm renal nephromax HCPCS C1726 | $773.06 | $1,405.57 | not published | 0 |
| Bln inpact admiral 4x150x130cm HCPCS C2623 | $2,560.98 | $4,656.32 | not published | 0 |
| Block brachial plexus w/cath plmt w/img CPT 64416 | $1,306.25 | $2,375.00 | $2,654.00 – $3,030.00 | 3 |
| Block femoral nerve cont infusion cath w/img CPT 64448 | $1,312.85 | $2,387.00 | $2,654.00 – $3,030.00 | 3 |
| Block paracervical nrv CPT 64435 | not published | not published | $2,654.00 – $3,030.00 | 3 |
| Block plantar digital nerve CPT 64455 | $601.15 | $1,093.00 | $1,887.00 – $2,654.00 | 3 |
| Block tap inj(s) w/wo img bi CPT 64488 | $1,413.50 | $2,570.00 | $1,887.00 – $5,512.00 | 3 |
| Block tap inj(s) w/wo img uni CPT 64486 | $779.90 | $1,418.00 | $1,887.00 – $5,512.00 | 3 |
| Blood Clotting (PT/INR) Test CPT 85610 | $31.35 | $57.00 | $4.29 – $7.94 | 4 |
| Blood Clotting (PTT) Test CPT 85730 | $19.80 | $36.00 | $6.01 – $12.16 | 4 |
| Blood Count (CBC) Test CPT 85025 | $75.35 | $137.00 | $7.77 – $15.72 | 4 |
| Blood Count (CBC) Test (without differential) CPT 85027 | $59.40 | $108.00 | $6.47 – $13.08 | 4 |
| Blood count spun microhematocrit CPT 85013 | not published | not published | $4.79 – $12.25 | 4 |
| Blood Culture Test CPT 87040 | $126.50 | $230.00 | $10.32 – $20.90 | 4 |
| Blood draw capillary 36416 CPT 36416 | $14.85 | $27.00 | $2.89 – $4.08 | 2 |
| Blood gases o2 saturation direct measurement CPT 82805 | $156.75 | $285.00 | $57.42 – $137.85 | 4 |
| Blood gases ph venous CPT 82800 | $62.70 | $114.00 | $11.00 – $19.25 | 4 |
| Blood occult fecal hemoglobin immunoassay qualitative 1-3 simultaneous determinations diagnostic CPT 82274 | $89.10 | $162.00 | $15.92 – $32.20 | 4 |
| Blood occult feces 1-3 determinations other than neoplasm screening qualitative CPT 82272 | $18.70 | $34.00 | $4.23 – $7.40 | 4 |
| Blood occult feces colorectal neoplasm screening qualitative CPT 82270 | not published | not published | $4.38 – $7.67 | 4 |
| Blood occult peroxidase activity qualitative gastric CPT 82271 | $28.60 | $52.00 | $5.32 – $9.31 | 4 |
| Blood smear interpretation CPT 85060 | not published | not published | $25.26 – $36.24 | 2 |
| Blood smear microscopic w manual differential wbc count CPT 85007 | $12.10 | $22.00 | $3.80 – $6.96 | 4 |
| Blood typing abo CPT 86900 | $166.65 | $303.00 | $2.99 – $5.54 | 4 |
| Blood typing ag donor ea ag CPT 86902 | $457.60 | $832.00 | $6.35 – $11.11 | 4 |
| Blood typing patient serum CPT 86904 | $89.65 | $163.00 | $16.34 – $28.60 | 4 |
| Blood typing rbc ag non abo/rh ea CPT 86905 | $457.60 | $832.00 | $3.83 – $7.75 | 4 |
| Blood typing rh (d) CPT 86901 | $159.50 | $290.00 | $2.99 – $5.54 | 4 |
| Blood typing rh phenotype complete reference CPT 86906 | $43.45 | $79.00 | $7.75 – $15.67 | 4 |
| Blood volume CPT 78122 | not published | not published | $263.54 – $263.54 | 1 |
| Blue light cysto imag agent HCPCS C9738 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Bone biopsy open superficial CPT 20240 | $6,503.75 | $11,825.00 | $3,735.00 – $7,791.00 | 3 |
| Bone Density Scan (DEXA) CPT 77080 | $304.15 | $553.00 | $102.88 – $102.88 | 1 |
| Bone imaging multiple areas CPT 78305 | not published | not published | $657.99 – $657.99 | 1 |
| Bone/joint imaging ltd area CPT 78300 | $1,936.00 | $3,520.00 | $517.78 – $517.78 | 1 |
| Bone marrow;aspiration only 38220 CPT 38220 | $1,587.30 | $2,886.00 | $2,959.00 – $3,388.00 | 3 |
| Bone marrow biopsyneedle/trocar 38221 CPT 38221 | $1,881.00 | $3,420.00 | $2,959.00 – $3,388.00 | 3 |
| Bone marrow harvest allogen CPT 38230 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Bone marrow harvest autolog CPT 38232 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Bone marrow imaging body CPT 78104 | $1,936.00 | $3,520.00 | $715.01 – $715.01 | 1 |
| Bone marrow imaging ltd CPT 78102 | $1,936.00 | $3,520.00 | $494.01 – $494.01 | 1 |
| Bone marrow imaging mult CPT 78103 | not published | not published | $643.74 – $643.74 | 1 |
| Bone marrow interpretation CPT 85097 | not published | not published | $73.38 – $628.20 | 2 |
| Bone/skin graft great toe CPT 20973 | not published | not published | $6,779.00 – $18,364.00 | 3 |
| Bone/skin graft metatarsal CPT 20972 | not published | not published | $6,779.00 – $18,364.00 | 3 |
| Bone survey-lead poisoning CPT 77074 | $304.15 | $553.00 | $137.35 – $137.35 | 1 |
| Boot j walker l HCPCS L4386 | $180.46 | $328.11 | not published | 0 |
| Borrelia antibody CPT 86619 | not published | not published | $13.38 – $27.07 | 4 |
| Borrelia burgdorferi (lyme disease) antibody nonspecific CPT 86618 | $135.85 | $247.00 | $17.03 – $34.46 | 4 |
| Borrelia miyamotoi amp prb CPT 87478 | not published | not published | $35.09 – $61.41 | 4 |
| Bortezomib 3.5 mg (2.5 mg/ml) solution for subcutaneous injection HCPCS J9041 | not published | not published | $2.40 – $6.04 | 5 |
| (both sides) smear without diff wbc count CPT 85008 | $11.00 | $20.00 | $3.43 – $6.96 | 4 |
| Bowel imaging CPT 78290 | $1,936.00 | $3,520.00 | $1,036.53 – $1,036.53 | 1 |
| Brace knee hing pat open med HCPCS L1820 | $109.90 | $199.82 | not published | 0 |
| Brace knee playmaker ii x-rom hook and loop xl HCPCS L1833 | $202.94 | $368.99 | not published | 0 |
| Brace knee postop tscope xl HCPCS L1845 | $658.79 | $1,197.80 | not published | 0 |
| Brace oths wrist hnd fngr without HCPCS L3807 | $260.39 | $473.44 | not published | 0 |
| Brace wrist classic lft sm HCPCS L3908 | $66.19 | $120.35 | not published | 0 |
| Brachioplasty 15836 CPT 15836 | not published | not published | $3,579.00 – $4,761.00 | 3 |
| Brach/thor cath 1st CPT 36215 | $1,686.85 | $3,067.00 | $1,887.00 – $5,512.00 | 3 |
| Brach/thor cath 2nd CPT 36216 | $1,940.40 | $3,528.00 | $1,887.00 – $5,512.00 | 3 |
| Brach/thor cath 3rd CPT 36217 | $3,131.15 | $5,693.00 | $1,887.00 – $5,512.00 | 3 |
| Brach/thor cath addl CPT 36218 | $3,766.40 | $6,848.00 | $1,887.00 – $5,512.00 | 3 |
| Brachytx isodose complex CPT 77318 | not published | not published | $682.69 – $682.69 | 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.