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 |
|---|---|---|---|---|
| Rpr pul art unifocal without cpb CPT 33925 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Rpr rem hernia init reduce CPT 49550 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Rpr tga aortic pulm art rcns CPT 33778 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Rpr tga atr bfl clsr vsd CPT 33776 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Rpr tga atr bfl rmvl plm bnd CPT 33775 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Rpr tga atrial baffle px CPT 33774 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Rpr tga bfl rpr sbpulm obstr CPT 33777 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Rpr tga rcnstj clsr vsd CPT 33780 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Rpr tga rcnstj rmvl plm bnd CPT 33779 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Rpr tga rcnstj rpr sbpl obst CPT 33781 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Rpr tga without surg enlgmnt vsd CPT 33770 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Rpr tga w/surg enlgmnt vsd CPT 33771 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Rpr xtnsr tndn leg prim without grft ea tndn CPT 27664 | not published | not published | $6,779.00 – $8,770.00 | 3 |
| Rrp hypspad comp moblj&urtp CPT 54344 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Rsect hip tum incl femur CPT 27078 | not published | not published | $3,735.00 – $18,364.00 | 3 |
| Rsv assay w/optic CPT 87807 | not published | not published | $13.10 – $24.26 | 4 |
| Rsv vacc mrna lipid nano im CPT 90683 | not published | not published | $947.43 – $947.43 | 1 |
| Rubella antibody igg CPT 86762 | $330.00 | $600.00 | $14.39 – $29.12 | 4 |
| Rubeola ag if CPT 87283 | not published | not published | $24.26 – $106.40 | 4 |
| Rubeola antibody igg CPT 86765 | $105.60 | $192.00 | $12.88 – $26.06 | 4 |
| Runx1 gene targeted seq alys CPT 81334 | not published | not published | $329.51 – $576.64 | 4 |
| Russell viper venom diluted CPT 85613 | $139.15 | $253.00 | $9.58 – $19.38 | 4 |
| Rx metab gen seq alys pnl 6 CPT 81418 | not published | not published | $917.08 – $1,604.89 | 4 |
| Sacituzumab govitecan-hziy 180 mg intravenous solution HCPCS J9317 | not published | not published | $38.37 – $96.49 | 5 |
| Salivary gland function exam CPT 78232 | not published | not published | $271.81 – $271.81 | 1 |
| Salivary gland imaging CPT 78230 | not published | not published | $420.35 – $420.35 | 1 |
| Salivary glnd img serial img CPT 78231 | not published | not published | $358.57 – $358.57 | 1 |
| Salmonella antibody CPT 86768 | not published | not published | $13.19 – $23.08 | 4 |
| Salpingostomy 58770 CPT 58770 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Sargramostim injection HCPCS J2820 | not published | not published | $64.98 – $163.40 | 5 |
| Sars-cov-2 antb quantitative CPT 86413 | not published | not published | $42.13 – $90.00 | 4 |
| Sarscov2 vac 5mcg/0.5ml im CPT 91304 | not published | not published | $0.01 – $439.79 | 4 |
| Sarscov coronavirus ag ia CPT 87426 | $55.55 | $101.00 | $44.16 – $61.83 | 4 |
| Sarscov & inf vir a&b ag ia CPT 87428 | not published | not published | $45.96 – $123.01 | 4 |
| S bowel endoscope w/stent CPT 44379 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Sbrt management CPT 77435 | not published | not published | $2,138.13 – $2,138.13 | 1 |
| Scan duplex abd/pelvis/retroperitoneal complete CPT 93975 | $1,599.40 | $2,908.00 | not published | 0 |
| Scan duplex abd/pelvis/retroperitoneal limited CPT 93976 | $684.75 | $1,245.00 | not published | 0 |
| Scan duplex aorta/ivc/iliac or bypass grafts complete CPT 93978 | $750.20 | $1,364.00 | not published | 0 |
| Scan duplex extracranial arteries unilateral/limited study CPT 93882 | $481.80 | $876.00 | not published | 0 |
| Scan duplex extremity veins unilateral/limited study CPT 93971 | $782.65 | $1,423.00 | not published | 0 |
| Scan duplex lower extremity arteries complete bilateral CPT 93925 | $1,456.95 | $2,649.00 | not published | 0 |
| Scan duplex lower extremity arteries unilateral/limited study left CPT 93926 | $725.45 | $1,319.00 | not published | 0 |
| Scan duplex upper extremity arteries unilateral/limited study left CPT 93931 | $420.20 | $764.00 | not published | 0 |
| Scan proc cranial extra CPT 61782 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Scan proc cranial intra 61781 CPT 61781 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Scan proc spinal CPT 61783 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Sclerotherapy fluid collection pq w/img CPT 49185 | $749.10 | $1,362.00 | $2,654.00 – $3,030.00 | 3 |
| Scope plantar fasciotomy CPT 29893 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Scope uretscp lithovue dig disp HCPCS C1747 | $1,959.99 | $3,563.62 | not published | 0 |
| Scr c/v cyto, automated sys HCPCS G0147 | not published | not published | $15.12 – $31.83 | 4 |
| Scr c/v cyto,autosys and md HCPCS G0141 | not published | not published | $26.35 – $26.35 | 1 |
| Scr c/v cyto, autosys, rescr HCPCS G0148 | not published | not published | $21.40 – $55.90 | 4 |
| Scr c/v cyto,thinlayer,rescr HCPCS G0144 | not published | not published | $43.24 – $76.95 | 4 |
| Scr c/v cyto,thinlayer,rescr HCPCS G0145 | not published | not published | $26.49 – $53.35 | 4 |
| Scr c/v cyto,thinlayer,rescr HCPCS G0143 | not published | not published | $27.05 – $47.34 | 4 |
| Screen cerv/vag thin layer HCPCS G0123 | not published | not published | $20.26 – $40.98 | 4 |
| Screen c/v thin layer by md HCPCS G0124 | not published | not published | $26.35 – $26.35 | 1 |
| Screening Colonoscopy (average risk) HCPCS G0121 | not published | not published | $1,276.45 – $3,030.00 | 3 |
| Screening Colonoscopy (high risk) HCPCS G0105 | not published | not published | $2,654.00 – $3,030.00 | 3 |
| Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations HCPCS G0328 | not published | not published | $18.05 – $32.20 | 4 |
| Screening hepatitis b non-obstetric high risk HCPCS G0499 | not published | not published | $28.27 – $51.85 | 4 |
| Screening hepatitis c antibody high risk HCPCS G0472 | not published | not published | $28.88 – $81.11 | 4 |
| Screening HIV antigen/antibody combination assay HCPCS G0475 | not published | not published | $24.08 – $49.06 | 4 |
| Screening Mammogram CPT 77067 | $217.25 | $395.00 | $120.90 – $120.90 | 1 |
| Screening pap smear by phys HCPCS P3001 | not published | not published | $26.35 – $26.35 | 1 |
| Screening prostate cancer PSA HCPCS G0103 | $136.95 | $249.00 | $19.31 – $37.22 | 4 |
| Screen pap by tech w md supv HCPCS P3000 | not published | not published | $15.12 – $31.83 | 4 |
| Screen/visual acuity/bilat/quant 99173 CPT 99173 | $6.60 | $12.00 | not published | 0 |
| Screw cortex 2.0 x 10mm HCPCS C1713 | $1,147.61 | $2,086.57 | not published | 0 |
| Sec abd wall suture evisceration/dehsn 49900 CPT 49900 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Sec art mech thrmbc non-intracranial add-on CPT 37186 | $1,500.95 | $2,729.00 | $1,887.00 – $5,512.00 | 3 |
| Sedation moderate same physician performing a gastrointestinal endoscopic service >= 5 years initial 15 minutes intra-service time HCPCS G0500 | $95.15 | $173.00 | not published | 0 |
| Sedimentation rate erythrocyte automated CPT 85652 | $29.15 | $53.00 | $2.70 – $5.47 | 4 |
| Seg acet and eth estr yearly HCPCS J7294 | not published | not published | $7,907.94 – $7,907.94 | 1 |
| Segmentectomy 32484 CPT 32484 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Semen analysis HCPCS G0027 | not published | not published | $6.50 – $13.15 | 4 |
| Semen analysis presence/motility CPT 89321 | $94.60 | $172.00 | $12.05 – $24.38 | 4 |
| Semen analysis w/count CPT 89310 | not published | not published | $8.61 – $17.44 | 4 |
| Separate eyelid adhesions CPT 68340 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Sept9 promoter methylation analysis CPT 81327 | not published | not published | $124.28 – $336.00 | 4 |
| Sequestrectomy olecrn proces CPT 24138 | not published | not published | $6,779.00 – $8,770.00 | 3 |
| Sequestrectomy radial h/n CPT 24136 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Sequestrectomy shft/dstl hum CPT 24134 | not published | not published | $6,779.00 – $8,770.00 | 3 |
| Sermorelin acetate injection HCPCS Q0515 | not published | not published | $3.51 – $3.51 | 1 |
| Serpina1 gene CPT 81332 | $116.05 | $211.00 | $43.65 – $88.33 | 4 |
| Sertraline (zoloft) - sendout CPT 80332 | $188.65 | $343.00 | $35.06 – $35.06 | 1 |
| Set radiation therapy field CPT 77280 | $633.05 | $1,151.00 | $794.40 – $794.40 | 1 |
| Set radiation therapy field CPT 77285 | $1,033.45 | $1,879.00 | $1,261.35 – $1,261.35 | 1 |
| Set radiation therapy field CPT 77290 | $1,352.45 | $2,459.00 | $1,453.86 – $1,453.86 | 1 |
| Set-up cardiovert-defibrill CPT 93745 | not published | not published | $1,887.00 – $2,334.00 | 2 |
| Sevelamer carbonate 800 mg tablet HCPCS J0601 | not published | not published | $0.30 – $0.30 | 1 |
| Sevelamer carbonate pdr 20mg HCPCS J0602 | not published | not published | $0.83 – $0.83 | 1 |
| Sever cranial nerve CPT 64771 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Sex chromatin identification CPT 88130 | not published | not published | $17.98 – $31.47 | 4 |
| Sex chromatin identification CPT 88140 | not published | not published | $7.99 – $16.19 | 4 |
| Sex transformation f to m CPT 55980 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Sex transformation m to f CPT 55970 | not published | not published | $3,388.00 – $3,388.00 | 1 |
| Sf3b1 gene common variants CPT 81347 | not published | not published | $193.25 – $338.19 | 4 |
| Sgmdsc w/band ligation CPT 45350 | not published | not published | $3,388.00 – $4,761.00 | 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.