Waupun Memorial Hospital

620 W Brown St, Waupun, WI 53963 · (920) 324-6512

Critical Access HospitalsVoluntary non-profit - PrivateCMS rating 5/5Fond du Lac, WI metro

Price file

Prices published

File dated 2026-04-01

615 price rows for 65 procedures

Published prices

cash · negotiated range · list

Basic metabolic panel (blood test)

CPT 80048 · lowest of 2 lines · metro median $97

$97

cash

$8 to $17

6 negotiated rates

$177

list

CT scan of the abdomen and pelvis, with contrast

CPT 74177 · metro median $1,713

$1,713

cash

$729 to $755

3 negotiated rates

$3,115

list

CT scan of the head, no contrast

CPT 70450 · metro median $1,375

$1,375

cash

$242 to $251

3 negotiated rates

$2,500

list

CT scan of the pelvis, with contrast

CPT 72193 · metro median $1,558

$1,558

cash

$556 to $575

3 negotiated rates

$2,833

list

Cataract surgery with lens implant

CPT 66984

—

cash

$3,388 to $7,791

8 negotiated rates

—

list

Cesarean delivery with prenatal and postpartum care

CPT 59510

—

cash

$3,735 to $4,589

3 negotiated rates

—

list

Cesarean section hospital stay, no complications

MS-DRG 788

—

cash

$10,467 to $19,724

12 negotiated rates

—

list

Chlamydia test (DNA)

CPT 87491 · lowest of 5 lines · metro median $72

$72

cash

$35 to $71

6 negotiated rates

$130

list

Colonoscopy (diagnostic)

CPT 45378

—

cash

$1,543 to $4,761

8 negotiated rates

—

list

Colonoscopy with biopsy

CPT 45380

—

cash

$1,543 to $4,761

8 negotiated rates

—

list

Colonoscopy with polyp removal

CPT 45385

—

cash

$1,543 to $4,761

8 negotiated rates

—

list

Complete blood count (CBC) with differential

CPT 85025 · metro median $75

$75

cash

$8 to $16

6 negotiated rates

$137

list

Comprehensive metabolic panel (blood test)

CPT 80053 · lowest of 2 lines · metro median $133

$133

cash

$11 to $21

6 negotiated rates

$241

list

Diagnostic mammogram (both breasts)

CPT 77066 · metro median $399

$399

cash

$146 to $146

1 negotiated rates

$726

list

Established patient office visit (about 40 minutes)

CPT 99215 · lowest of 4 lines · metro median $90

$90

cash

—

$164

list

Family psychotherapy with the patient

CPT 90847 · lowest of 2 lines · metro median $119

$119

cash

—

$216

list

Family psychotherapy without the patient

CPT 90846 · lowest of 2 lines · metro median $119

$119

cash

—

$217

list

Gallbladder removal (laparoscopic)

CPT 47562

—

cash

$5,257 to $18,364

8 negotiated rates

—

list

Gonorrhea test (DNA)

CPT 87591 · lowest of 5 lines · metro median $78

$78

cash

$35 to $71

6 negotiated rates

$142

list

Group psychotherapy

CPT 90853 · lowest of 3 lines · metro median $114

$114

cash

—

$207

list

Hip or knee replacement, no major complications

MS-DRG 470

—

cash

$21,058 to $39,681

12 negotiated rates

—

list

Hospital stay for digestive disorders, no complications

MS-DRG 392

—

cash

$8,511 to $16,038

12 negotiated rates

—

list

Hysterectomy for non-cancer reasons, no complications

MS-DRG 743

—

cash

$13,545 to $25,524

12 negotiated rates

—

list

Inguinal hernia repair (age 5 and up)

CPT 49505

—

cash

$3,735 to $8,770

8 negotiated rates

—

list

Knee arthroscopy with meniscus repair

CPT 29881

—

cash

$3,735 to $8,770

8 negotiated rates

—

list

Laser treatment after cataract surgery (YAG)

CPT 66821

—

cash

$2,654 to $3,335

7 negotiated rates

—

list

Left heart catheterization

CPT 93452

—

cash

$3,735 to $16,106

7 negotiated rates

—

list

Lipid panel (cholesterol test)

CPT 80061 · metro median $119

$119

cash

$13 to $27

6 negotiated rates

$216

list

Liver function panel

CPT 80076 · metro median $94

$94

cash

$8 to $17

6 negotiated rates

$170

list

MRI of the brain, with and without contrast

CPT 70553 · metro median $1,844

$1,844

cash

$870 to $901

3 negotiated rates

$3,352

list

MRI of the knee or other lower joint, no contrast

CPT 73721 · metro median $2,297

$2,297

cash

$557 to $577

3 negotiated rates

$4,176

list

MRI of the lower back (lumbar spine), no contrast

CPT 72148 · metro median $2,257

$2,257

cash

$490 to $508

3 negotiated rates

$4,104

list

MRI of the neck (cervical spine), no contrast

CPT 72141 · metro median $1,784

$1,784

cash

$494 to $511

3 negotiated rates

$3,244

list

Neck (cervical) spinal fusion, no complications

MS-DRG 473

—

cash

$26,652 to $50,222

12 negotiated rates

—

list

Nerve block injection, lower back, with imaging guidance

CPT 64483 · lowest of 2 lines · metro median $2,227

$2,227

cash

$1,221 to $3,335

8 negotiated rates

$4,049

list

New patient office visit (about 30 minutes)

CPT 99203 · lowest of 2 lines · metro median $65

$65

cash

—

$119

list

New patient office visit (about 45 minutes)

CPT 99204 · lowest of 2 lines · metro median $80

$80

cash

—

$146

list

New patient office visit (about 60 minutes)

CPT 99205 · lowest of 2 lines · metro median $92

$92

cash

—

$167

list

PSA test (prostate)

CPT 84153 · lowest of 3 lines · metro median $120

$120

cash

$18 to $37

6 negotiated rates

$218

list

Partial thromboplastin time (blood clotting test)

CPT 85730 · lowest of 4 lines · metro median $20

$20

cash

$6 to $12

6 negotiated rates

$36

list

Physical therapy, therapeutic exercise (15 minutes)

CPT 97110 · lowest of 3 lines · metro median $69

$69

cash

—

$125

list

Pregnancy ultrasound (after first trimester)

CPT 76805 · lowest of 2 lines · metro median $401

$401

cash

$306 to $317

3 negotiated rates

$729

list

Prostate biopsy

CPT 55700 · metro median $367

$367

cash

$3,388 to $4,761

7 negotiated rates

$668

list

Prostate removal (laparoscopic)

CPT 55866

—

cash

$7,609 to $27,583

7 negotiated rates

—

list

Prothrombin time (blood clotting test)

CPT 85610 · lowest of 8 lines · metro median $23

$23

cash

$4 to $8

6 negotiated rates

$41

list

Psychotherapy, 30 minutes

CPT 90832 · lowest of 3 lines · metro median $92

$92

cash

—

$168

list

Psychotherapy, 45 minutes

CPT 90834 · lowest of 4 lines · metro median $97

$97

cash

—

$176

list

Psychotherapy, 60 minutes

CPT 90837 · lowest of 3 lines · metro median $91

$91

cash

—

$165

list

Removal of a breast lump (biopsy by excision)

CPT 19120

—

cash

$3,735 to $7,791

7 negotiated rates

—

list

Screening mammogram (both breasts)

CPT 77067 · lowest of 2 lines · metro median $109

$109

cash

$121 to $121

1 negotiated rates

$198

list

Shoulder arthroscopy with decompression

CPT 29826

—

cash

$1,887 to $8,265

8 negotiated rates

—

list

Sleep study (overnight, attended)

CPT 95810 · lowest of 2 lines · metro median $3,214

$3,214

cash

—

$5,844

list

Spinal injection, lower back, no imaging guidance

CPT 62322 · metro median $1,073

$1,073

cash

$2,654 to $3,335

7 negotiated rates

$1,950

list

Spinal injection, lower back, with imaging guidance

CPT 62323 · metro median $1,709

$1,709

cash

$2,654 to $3,335

7 negotiated rates

$3,107

list

TSH test (thyroid)

CPT 84443 · lowest of 2 lines · metro median $139

$139

cash

$17 to $34

6 negotiated rates

$252

list

Tonsils and adenoids removal (under age 12)

CPT 42820

—

cash

$4,226 to $7,791

8 negotiated rates

—

list

Transvaginal ultrasound

CPT 76830 · metro median $409

$409

cash

$292 to $302

3 negotiated rates

$744

list

Ultrasound of the abdomen (complete)

CPT 76700 · metro median $674

$674

cash

$275 to $285

3 negotiated rates

$1,226

list

Upper endoscopy (EGD)

CPT 43235 · metro median $361

$361

cash

$1,484 to $4,761

8 negotiated rates

$657

list

Upper endoscopy with biopsy

CPT 43239

—

cash

$1,484 to $4,761

8 negotiated rates

—

list

Urinalysis with microscope

CPT 81001 · metro median $58

$58

cash

$3 to $6

6 negotiated rates

$105

list

Vaginal delivery after a previous cesarean

CPT 59610

—

cash

$3,735 to $4,589

3 negotiated rates

—

list

Vaginal delivery hospital stay, no complications

MS-DRG 807

—

cash

$7,360 to $13,870

12 negotiated rates

—

list

Vaginal delivery with prenatal and postpartum care

CPT 59400

—

cash

$3,735 to $4,589

3 negotiated rates

—

list

X-ray of the lower spine (4 or more views)

CPT 72110 · metro median $304

$304

cash

$109 to $113

3 negotiated rates

$553

list

Source files

The machine-readable files this hospital lists in its cms-hpt.txt. Every price above comes from one of them.

https://hospitalpricedisclosure.com/download.aspx?pi=qrjjGipjrFx4NGWFLmvnSg*-*&f=p22CpYLrWLxCnt4HoK7iZA*-*
SSM Health Waupun Memorial Hospital · parsed · json v3.0.0 · file dated 2026-04-01 · 30.1 MB · 615 price rows read · read Nov 2026