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 |
|---|---|---|---|---|
| Vaccine dtap-hep b-ipv im CPT 90723 | not published | not published | $309.85 – $309.85 | 1 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | not published | not published | $415.37 – $415.37 | 1 |
| Vaccine dtap-ipv-hib-hepb im CPT 90697 | not published | not published | $1,018.73 – $1,018.73 | 1 |
| Vaccine dtap-ipv/hib im CPT 90698 | not published | not published | $367.50 – $367.50 | 1 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | not published | not published | $99.48 – $99.48 | 1 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | not published | not published | $42.42 – $42.42 | 1 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | not published | not published | $79.38 – $194.96 | 4 |
| Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im CPT 90636 | not published | not published | $352.09 – $352.09 | 1 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | not published | not published | $114.30 – $114.30 | 1 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im CPT 90634 | not published | not published | $79.25 – $79.25 | 1 |
| Vaccine hepatitis b (hepb) adolescent 2 dose im CPT 90743 | not published | not published | $82.67 – $204.60 | 4 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | not published | not published | $77.42 – $191.61 | 4 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | not published | not published | $195.32 – $458.21 | 4 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | not published | not published | $34.84 – $83.77 | 4 |
| Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 | not published | not published | $1,004.55 – $1,004.55 | 1 |
| Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im CPT 90649 | not published | not published | $286.21 – $286.21 | 1 |
| Vaccine influenza (iiv) preservative free antigen content im CPT 90662 | not published | not published | $91.84 – $227.30 | 4 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | not published | not published | $91.84 – $227.30 | 4 |
| Vaccine influenza nos 0.5ml dose im CPT 90658 | not published | not published | $24.05 – $59.52 | 4 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | not published | not published | $24.59 – $60.85 | 4 |
| Vaccine influenza quadrivalent live (laiv4) intranasal CPT 90672 | not published | not published | $82.73 – $82.73 | 1 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | not published | not published | $40.54 – $100.32 | 4 |
| Vaccine influenza trivalent (iiv3) 0.25ml dose im CPT 90657 | not published | not published | $12.02 – $29.75 | 4 |
| Vaccine mengingoccocal serogroup b 2 dose im CPT 90620 | not published | not published | $678.32 – $678.32 | 1 |
| Vaccine mengingoccocal serogroup b 2 or 3 dose im CPT 90621 | not published | not published | $621.16 – $621.16 | 1 |
| Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im CPT 90619 | not published | not published | $561.41 – $561.41 | 1 |
| Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im CPT 90734 | not published | not published | $494.92 – $494.92 | 1 |
| Vaccine mmr live subcutaneous CPT 90707 | not published | not published | $305.38 – $305.38 | 1 |
| Vaccine mmrv live subcutaneous CPT 90710 | not published | not published | $907.10 – $907.10 | 1 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | not published | not published | $146.82 – $363.38 | 4 |
| Vaccine pneumococcal conjugate 13 valent (pcv13) im CPT 90670 | not published | not published | $283.79 – $702.37 | 4 |
| Vaccine pneumonococcal conjugate 15 valent (pcv15) im CPT 90671 | not published | not published | $287.27 – $690.31 | 4 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | not published | not published | $344.19 – $811.42 | 4 |
| Vaccine polio (ipv) subcutaneous/im CPT 90713 | not published | not published | $145.73 – $145.73 | 1 |
| Vaccine rabies im CPT 90675 | not published | not published | $349.44 – $892.39 | 4 |
| Vaccine respiratory syncytial virus bivalent subunit/preservative free im CPT 90678 | not published | not published | $963.77 – $963.77 | 1 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im CPT 90380 | not published | not published | $3,396.05 – $3,396.05 | 1 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im CPT 90381 | not published | not published | $1,698.03 – $1,698.03 | 1 |
| Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im CPT 90679 | not published | not published | $960.50 – $960.50 | 1 |
| Vaccine rotavirus attenuated (rv1) live 2 dose oral CPT 90681 | not published | not published | $301.90 – $301.90 | 1 |
| Vaccine rotavirus pentavalent (rv5) live 3 dose oral CPT 90680 | not published | not published | $322.43 – $322.43 | 1 |
| Vaccine tdap >=7 years im CPT 90715 | not published | not published | $42.98 – $105.17 | 4 |
| Vaccine td preservative free >= 7 years im CPT 90714 | not published | not published | $37.36 – $91.15 | 4 |
| Vaccine typhoid vicps im CPT 90691 | not published | not published | $321.67 – $321.67 | 1 |
| Vaccine varicella live subcutaneous CPT 90716 | not published | not published | $597.45 – $597.45 | 1 |
| Vaccine yellow fever live subcutaneous CPT 90717 | not published | not published | $480.74 – $480.74 | 1 |
| Vaccinia vrs vac 0.3 ml perq CPT 90622 | not published | not published | $0.01 – $0.03 | 2 |
| Vag hys/<250g/rmv tube/rpr entero 58263 CPT 58263 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Vag hyst incl t/o complex CPT 58291 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Vag hyst including t/o CPT 58262 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Vag hyst t/o & repair compl CPT 58292 | not published | not published | $7,609.00 – $16,106.00 | 3 |
| Vag hyst w/enterocele compl 58294 CPT 58294 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Vag hyst w/enterocele repair CPT 58270 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Vaginal bx CPT 58999 | not published | not published | $1,887.00 – $10,779.00 | 3 |
| Vaginal delivery after cesarean delivery 59612 CPT 59612 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Vaginal Delivery (full care) CPT 59400 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Vaginal hysterectomy CPT 58260 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Vaginectomy partial w/nodes CPT 57109 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Vagnc compl rmvl paravag tis CPT 57111 | not published | not published | $4,428.00 – $8,770.00 | 3 |
| Vagnc compl rmvl vag wall CPT 57110 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Vagotomy pfrmd w/prtl dstl gstrct 43635 CPT 43635 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Vagotomy & pylorus repair CPT 43641 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Vagotomy & pylorus repair 43640 CPT 43640 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Valproic acid total therapeutic drug level CPT 80164 | $119.90 | $218.00 | $13.54 – $27.43 | 4 |
| Valrubicin injection HCPCS J9357 | not published | not published | $1,507.72 – $3,791.14 | 5 |
| Valvuloplasty aortic CPT 92986 | $6,168.25 | $11,215.00 | $17,314.00 – $18,364.00 | 2 |
| Valvuloplasty mitral CPT 92987 | $10,877.90 | $19,778.00 | $17,314.00 – $18,364.00 | 2 |
| Valvuloplasty pulmonary CPT 92990 | not published | not published | $17,314.00 – $18,364.00 | 2 |
| Valvuloplasty/tv without ring insert 33463 CPT 33463 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Valvuloplasty/tv w/ring insertion 33464 CPT 33464 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Vancomycin 1,000 mg intravenous injection HCPCS J3373 | not published | not published | $0.06 – $0.06 | 1 |
| Vancomycin 750 mg intravenous solution HCPCS J3374 | not published | not published | $0.23 – $0.23 | 1 |
| Vancomycin hcl injection HCPCS J3370 | not published | not published | $2.01 – $5.07 | 4 |
| Vancomycin peak therapeutic drug level CPT 80202 | $123.20 | $224.00 | $13.54 – $27.43 | 4 |
| Vanomycin dna amp probe CPT 87500 | not published | not published | $35.09 – $71.00 | 4 |
| Vantas implant HCPCS J9225 | not published | not published | $12,416.94 – $12,416.94 | 1 |
| Varicella zoster antibody igg CPT 86787 | $185.35 | $337.00 | $11.77 – $22.54 | 4 |
| Varicella-zoster immue globin im CPT 90396 | not published | not published | $6,131.83 – $6,131.83 | 1 |
| Vasc emb/occ w/prs cath HCPCS C9797 | not published | not published | $5,512.00 – $5,512.00 | 1 |
| Vasc graft into carpal bone CPT 25430 | not published | not published | $3,735.00 – $16,106.00 | 3 |
| Vasectomy CPT 55250 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Vasopressin 20 unit/ml intravenous solution HCPCS J2598 | not published | not published | $1.56 – $4.44 | 5 |
| Vbac delivery 59610 CPT 59610 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Vbac/include postpartum care 59614 CPT 59614 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Vedolizumab 300 mg intravenous solution HCPCS J3380 | not published | not published | $23.28 – $59.00 | 5 |
| Vein bypass grft fem-popliteal 35583 CPT 35583 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Vein byp fem-tibial peroneal 35585 CPT 35585 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Vein byp pop-tibl peroneal CPT 35587 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Vein gft fem a/p tib/pero/dis art 35566 CPT 35566 | $12,057.10 | $21,922.00 | $4,428.00 – $4,428.00 | 1 |
| Vein x-ray adrenal gland CPT 75840 | not published | not published | $303.67 – $303.67 | 1 |
| Vein x-ray adrenal glands CPT 75842 | not published | not published | $351.92 – $351.92 | 1 |
| Vein x-ray eye socket CPT 75880 | not published | not published | $355.98 – $355.98 | 1 |
| Vein x-ray kidney CPT 75831 | $1,946.45 | $3,539.00 | $283.50 – $283.50 | 1 |
| Vein x-ray liver CPT 75891 | $3,305.50 | $6,010.00 | $297.74 – $297.74 | 1 |
| Vein x-ray liver w/hemodynam CPT 75885 | $7,461.85 | $13,567.00 | $295.36 – $295.36 | 1 |
| Vein x-ray liver w/hemodynam CPT 75889 | $3,719.10 | $6,762.00 | $295.36 – $295.36 | 1 |
| Vein x-ray liver without hemodyn CPT 75887 | $3,963.30 | $7,206.00 | $296.56 – $296.56 | 1 |
| Vein x-ray skull CPT 75870 | not published | not published | $301.32 – $301.32 | 1 |
| Vein x-ray skull epidural CPT 75872 | not published | not published | $289.41 – $289.41 | 1 |
| Vein x-ray spleen/liver CPT 75810 | not published | not published | $1,343.62 – $1,343.62 | 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.