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 |
|---|---|---|---|---|
| Unlisted procedure liver CPT 47399 | not published | not published | $2,959.00 – $10,779.00 | 3 |
| Unlisted procedure orbit CPT 67599 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted procedure pancreas CPT 48999 | not published | not published | $2,959.00 – $10,779.00 | 3 |
| Unlisted procedure rectum CPT 45999 | not published | not published | $2,959.00 – $10,779.00 | 3 |
| Unlisted procedure spine CPT 22899 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted procedure urinary 58750 CPT 58750 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Unlisted px abdomen muscskel CPT 22999 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px accessory sinus CPT 31299 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px ant segment eye CPT 66999 | not published | not published | $3,579.00 – $10,779.00 | 3 |
| Unlisted px arthroscopy CPT 29999 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px biliary tract CPT 47999 | not published | not published | $3,579.00 – $10,779.00 | 3 |
| Unlisted px casting/strpg CPT 29799 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px conjunctiva CPT 68399 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px diaphragm CPT 39599 | not published | not published | $10,779.00 – $10,779.00 | 1 |
| Unlisted px exc pressure ulc CPT 15999 | not published | not published | $2,959.00 – $10,779.00 | 3 |
| Unlisted px external ear CPT 69399 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px extraocular musc CPT 67399 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px foot/toes CPT 28899 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px forearm/wrist CPT 25999 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px hands/fingers CPT 26989 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Unlisted px inner ear CPT 69949 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Unlisted px lacrimal system CPT 68899 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px leg/ankle CPT 27899 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px male genital sys CPT 55899 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px mediastinum CPT 39499 | not published | not published | $10,779.00 – $10,779.00 | 1 |
| Unlisted px middle ear CPT 69799 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px neck/thorax CPT 21899 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px palate uvula CPT 42299 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px pelvis/hip joint CPT 27299 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px posterior segmnt CPT 67299 | not published | not published | $3,579.00 – $10,779.00 | 3 |
| Unlisted px salivry glnd/dux CPT 42699 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted px small intestine CPT 44799 | not published | not published | $3,579.00 – $10,779.00 | 3 |
| Unlisted px temporal bone CPT 69979 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Unlisted px tongue flr mouth CPT 41599 | $372.35 | $677.00 | $1,887.00 – $10,779.00 | 3 |
| Unlisted px vestibule mouth CPT 40899 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Unlisted reprod med lab proc CPT 89398 | not published | not published | $49.47 – $49.47 | 1 |
| Unlisted special svc px/rprt CPT 99199 | $205.15 | $373.00 | not published | 0 |
| Unlisted surgical path px CPT 88399 | not published | not published | $49.47 – $49.47 | 1 |
| Unlisted transfusion med px CPT 86999 | $73.70 | $134.00 | $22.99 – $22.99 | 1 |
| Unlisted ultrasound procedure CPT 76999 | $400.95 | $729.00 | not published | 0 |
| Unlisted vasc endoscopy px CPT 37501 | not published | not published | $2,654.00 – $3,030.00 | 3 |
| Unlstd laps px mat care&dlvr CPT 59898 | not published | not published | $5,257.00 – $16,106.00 | 3 |
| Unlstd laps px sprmatic cord CPT 55559 | not published | not published | $5,257.00 – $16,106.00 | 3 |
| Unsched dialysis esrd pt hos HCPCS G0257 | $680.90 | $1,238.00 | not published | 0 |
| Upgrade pm system CPT 33214 | $3,135.55 | $5,701.00 | $7,609.00 – $43,643.00 | 3 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $2,419.45 | $4,399.00 | $877.10 – $877.10 | 1 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $2,303.95 | $4,189.00 | $768.98 – $768.98 | 1 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $2,194.50 | $3,990.00 | $494.98 – $494.98 | 1 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | $361.35 | $657.00 | $1,484.00 – $4,761.00 | 4 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | not published | not published | $1,484.00 – $4,761.00 | 4 |
| Upper ext harvest for cabg1 seg 35600 CPT 35600 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Uppr gi scope w/submuc inj CPT 43236 | not published | not published | $2,654.00 – $4,761.00 | 3 |
| Urachal cyst/sinus excision 51500 CPT 51500 | not published | not published | $5,257.00 – $8,770.00 | 3 |
| Urea nitrogen CPT 84520 | $47.85 | $87.00 | $3.95 – $8.00 | 4 |
| Urea nitrogen 24 hour urine CPT 84540 | $46.75 | $85.00 | $5.56 – $9.73 | 4 |
| Urea nitrogen clearance CPT 84545 | not published | not published | $7.20 – $13.37 | 4 |
| Urea nitrogen semi-quant CPT 84525 | not published | not published | $5.13 – $8.98 | 4 |
| Ureteral embolization/occl CPT 50705 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Ureteral reflux study CPT 78740 | $1,936.00 | $3,520.00 | $657.99 – $657.99 | 1 |
| Ureter endoscopy CPT 50970 | not published | not published | $2,959.00 – $3,388.00 | 3 |
| Ureter endoscopy & biopsy CPT 50955 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Ureter endoscopy & biopsy CPT 50974 | not published | not published | $3,579.00 – $4,761.00 | 3 |
| Ureter endoscopy & catheter CPT 50972 | not published | not published | $2,959.00 – $3,735.00 | 3 |
| Ureter endoscopy & treatment CPT 50957 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Ureter endoscopy & treatment CPT 50961 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Ureter endoscopy & treatment CPT 50976 | not published | not published | $3,579.00 – $4,761.00 | 3 |
| Ureter endoscopy & treatment CPT 50980 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Ureteroneocystostomy 50780 CPT 50780 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Ureteroureterostomy 50760 CPT 50760 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | $457.60 | $832.00 | $181.08 – $181.08 | 1 |
| Urethrlys transvag with scope CPT 53500 | not published | not published | $3,735.00 – $8,770.00 | 3 |
| Urethrocystography void s&i CPT 74455 | $457.60 | $832.00 | $215.78 – $215.78 | 1 |
| Uric acid blood CPT 84550 | $40.15 | $73.00 | $4.52 – $9.16 | 4 |
| Uric acid urine CPT 84560 | $46.75 | $85.00 | $5.08 – $9.62 | 4 |
| Urinalysis glass test CPT 81020 | not published | not published | $4.70 – $8.23 | 4 |
| Urinalysis microscopic only CPT 81015 | $25.85 | $47.00 | $3.05 – $6.18 | 4 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | not published | not published | $2.17 – $4.39 | 4 |
| Urinalysis (with microscopy) CPT 81001 | $57.75 | $105.00 | $3.17 – $6.41 | 4 |
| Urinalysis (without microscopy) CPT 81003 | $24.75 | $45.00 | $2.25 – $4.55 | 4 |
| Urinary bldr retent nuc study CPT 78730 | not published | not published | $237.15 – $237.15 | 1 |
| Urinary reflex study CPT 51792 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Urine Culture Test CPT 87086 | $88.00 | $160.00 | $8.07 – $16.33 | 4 |
| Urine flow measurement 51736 CPT 51736 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Urine pregnancy test CPT 81025 | $58.30 | $106.00 | $8.61 – $15.07 | 4 |
| Urine screen for bacteria CPT 81007 | not published | not published | $5.20 – $52.47 | 4 |
| Urine shunt to intestine CPT 50815 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Urine specimen collect mult HCPCS P9615 | not published | not published | $3.00 – $15.91 | 4 |
| Urofollitropin, 75 iu HCPCS J3355 | not published | not published | $161.14 – $161.14 | 1 |
| Urography, antegrade CPT 74425 | $366.30 | $666.00 | $1,162.75 – $1,162.75 | 1 |
| Urography inf drip &/or bolus CPT 74410 | not published | not published | $277.56 – $277.56 | 1 |
| Use 1st target lesion CPT 76982 | $207.35 | $377.00 | $224.11 – $224.11 | 1 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | not published | not published | $13.81 – $34.73 | 5 |
| Ustekinumab 45 mg/0.5 ml subcutaneous solution HCPCS J3357 | not published | not published | $168.78 – $424.38 | 3 |
| U/s trtmt, not leiomyomata HCPCS C9734 | not published | not published | $7,529.00 – $7,791.00 | 2 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | not published | not published | $177.82 – $440.09 | 4 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | not published | not published | $161.77 – $400.37 | 4 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | not published | not published | $171.49 – $424.45 | 4 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | not published | not published | $96.56 – $238.99 | 4 |
| Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im CPT 91318 | not published | not published | $72.11 – $178.46 | 4 |
| Vaccine dtap < 7 years im CPT 90700 | not published | not published | $96.33 – $96.33 | 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.