SSM Health Waupun Memorial Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $8,519

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $4,833

• Breast MRI

  SSP RA011

  up to

  $2,802

• Breast Ultrasound

  SSP RA012

  up to

  $625

• Carpal Tunnel Repair

  SSP NU002

  up to

  $4,859

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $6,710

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $4,738

• Colonoscopy

  SSP GA002

  up to

  $6,321

• Colonoscopy via Stoma

  SSP GA000

  up to

  $5,975

• CT

  SSP RA001

  up to

  $2,161

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $2,773

• Delivery - Cesarean

  SSP OB002

  up to

  $24,959

• Delivery - Vaginal

  SSP OB001

  up to

  $16,214

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $7,780

• Fetal MRI

  SSP RA006

  up to

  $2,429

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $2,012

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $2,040

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $13,246

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $5,700

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $20,535

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $11,125

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $9,217

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $13,419

• MRI with Contrast

  SSP RA007

  up to

  $1,988

• MRI without Contrast

  SSP RA005

  up to

  $2,552

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $5,484

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $19,847

• Ultrasound

  SSP RA008

  up to

  $590

• X-Ray

  SSP RA000

  up to

  $545