SSM Health Ripon Community Hospital
845 Parkside St, Ripon, WI · SSM Health · · NPI 1053362624
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 |
|---|---|---|---|---|
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $1,495.45 | $2,719.00 | $428.45 – $428.45 | 1 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $2,488.75 | $4,525.00 | $872.35 – $872.35 | 1 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,369.95 | $4,309.00 | $765.40 – $765.40 | 1 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $2,257.20 | $4,104.00 | $490.24 – $490.24 | 1 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $304.15 | $553.00 | $77.94 – $77.94 | 1 |
| Lower jaw bone graft CPT 21215 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Loxapine for inhalation 1 mg HCPCS J2062 | not published | not published | $49.01 – $49.01 | 1 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $5,257.00 – $18,364.00 | 3 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $7,609.00 – $18,364.00 | 3 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $7,609.00 – $18,364.00 | 3 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $7,609.00 – $18,364.00 | 3 |
| L/s ratio fetal lung CPT 83661 | not published | not published | $21.99 – $44.50 | 4 |
| Lumbar diskogram s&i CPT 72295 | $3,359.40 | $6,108.00 | $183.68 – $183.68 | 1 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $7,609.00 – $18,364.00 | 3 |
| Lumizyme injection HCPCS J0221 | not published | not published | $218.32 – $548.97 | 5 |
| Lung function test (mbc/mvv) CPT 94200 | $369.60 | $672.00 | not published | 0 |
| Lung Function Test (Spirometry) CPT 94010 | $172.15 | $313.00 | not published | 0 |
| Lung perfusion imaging CPT 78580 | $1,936.00 | $3,520.00 | $701.95 – $701.95 | 1 |
| Lung transplant double CPT 32853 | not published | not published | $8,923.00 – $8,923.00 | 1 |
| Lung transplant single CPT 32851 | not published | not published | $8,923.00 – $8,923.00 | 1 |
| Lung transplant with bypass CPT 32852 | not published | not published | $8,923.00 – $8,923.00 | 1 |
| Lung transplant with bypass CPT 32854 | not published | not published | $8,923.00 – $8,923.00 | 1 |
| Lung volume reduction 32491 CPT 32491 | not published | not published | $7,609.00 – $7,609.00 | 1 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | not published | not published | $221.85 – $557.85 | 5 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | not published | not published | $44.69 – $112.38 | 5 |
| Lutetium lu 177 dotatat ther HCPCS A9513 | not published | not published | $806.54 – $806.54 | 1 |
| Lutetium lu 177 vipivotide HCPCS A9607 | not published | not published | $656.70 – $656.70 | 1 |
| Lw ntsty Ultrasound stimj bone healg CPT 20979 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Lyme dis dna dir probe CPT 87475 | not published | not published | $20.05 – $40.58 | 4 |
| Lymphadenect/stage/pelv/paraaortic 38562 CPT 38562 | not published | not published | $5,257.00 – $18,364.00 | 3 |
| Lymphatics/lymph node imaging CPT 78195 | $1,936.00 | $3,520.00 | $1,028.20 – $1,028.20 | 1 |
| Lymphocyte culture mixed CPT 86821 | not published | not published | $36.56 – $114.25 | 4 |
| Lymphocyte transformation mitogen CPT 86353 | not published | not published | $49.03 – $99.22 | 4 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $105.82 – $331.64 | 4 |
| Lymphocytotoxicity assay CPT 86806 | not published | not published | $47.59 – $96.30 | 4 |
| Lymph vessel x-ray arm/leg CPT 75801 | not published | not published | $712.62 – $712.62 | 1 |
| Lymph vessel x-ray arms/legs CPT 75803 | not published | not published | $684.20 – $684.20 | 1 |
| Lymph vessel x-ray trunk CPT 75805 | not published | not published | $760.95 – $760.95 | 1 |
| Lymph vessel x-ray trunk CPT 75807 | not published | not published | $734.95 – $734.95 | 1 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Lysis of labial adhesions CPT 56441 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | $3,388.00 – $7,791.00 | 3 |
| Lyumjev for insulin pump use HCPCS J1813 | not published | not published | $16.76 – $42.14 | 5 |
| Macro exam dissect molec study ea CPT 88387 | not published | not published | $7.22 – $13.02 | 2 |
| Macroscopic exam arthropod CPT 87168 | $10.45 | $19.00 | $4.27 – $8.64 | 4 |
| Macroscopic exam parasite CPT 87169 | $58.85 | $107.00 | $4.31 – $8.64 | 4 |
| Magnesium CPT 83735 | $116.05 | $211.00 | $6.70 – $13.54 | 4 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | not published | not published | $0.53 – $1.34 | 5 |
| Magnetic image bone marrow CPT 77084 | not published | not published | $1,029.18 – $1,029.18 | 1 |
| Makena, 10 mg HCPCS J1726 | not published | not published | $37.62 – $37.62 | 1 |
| Malaria antibody CPT 86750 | not published | not published | $13.19 – $26.70 | 4 |
| Male sling procedure CPT 53440 | not published | not published | $7,609.00 – $27,583.00 | 3 |
| Management of liver hemorrhage 47361 CPT 47361 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Manipulate finger w/anesth CPT 26340 | not published | not published | $1,887.00 – $3,388.00 | 3 |
| Manipulate wrist w/anesthes CPT 25259 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $91.30 | $166.00 | not published | 0 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $118.25 | $215.00 | not published | 0 |
| Manipulation of hip joint CPT 27275 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Manipulation of spine CPT 22505 | not published | not published | $3,388.00 – $4,761.00 | 3 |
| Manipulat palm cord post inj CPT 26341 | not published | not published | $1,887.00 – $2,654.00 | 3 |
| Mannitol 12.5 gm/50 ml inj HCPCS J2150 | not published | not published | $2.49 – $6.91 | 5 |
| Mannitol for inhaler HCPCS J7665 | not published | not published | $3.22 – $3.22 | 1 |
| Manual diff wbc count b-coat CPT 85009 | not published | not published | $5.07 – $8.87 | 4 |
| Mapping io sentinel lymph node CPT 38900 | not published | not published | $1,887.00 – $5,512.00 | 3 |
| Map tachycard site(s) CPT 93609 | $4,856.50 | $8,830.00 | $1,887.00 – $2,334.00 | 2 |
| Margetuximab-cmkb 25 mg/ml intravenous solution HCPCS J9353 | not published | not published | $53.38 – $134.49 | 5 |
| Marker biop eviva buckle ss HCPCS A4648 | $235.90 | $428.91 | not published | 0 |
| Marker lymphatic sentimag magtrace 10 vial HCPCS A9697 | not published | not published | $3,098.09 – $3,098.09 | 1 |
| Marsupialization liver lesion 47300 CPT 47300 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Mastectomy partial CPT 19301 | not published | not published | $3,735.00 – $7,791.00 | 3 |
| Mast mod rad CPT 19307 | not published | not published | $6,019.00 – $16,106.00 | 3 |
| Mastoidectomy CPT 69501 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Mastoidectomy complete 69502 CPT 69502 | not published | not published | $4,428.00 – $7,791.00 | 3 |
| Mastoids complete CPT 70130 | not published | not published | $123.08 – $123.08 | 1 |
| Mastoid surgery revision CPT 69603 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Mastopexy CPT 19316 | not published | not published | $6,019.00 – $8,770.00 | 3 |
| Mast radical CPT 19305 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Mast rad urban type CPT 19306 | not published | not published | $6,019.00 – $6,019.00 | 1 |
| Mast simple complete CPT 19303 | not published | not published | $6,019.00 – $8,770.00 | 3 |
| Matrion 1 sq cm HCPCS Q4201 | not published | not published | $94.99 – $231.50 | 4 |
| Matrix bone cryomatrix 2.0ml HCPCS Q4162 | not published | not published | $6,987.77 – $6,987.77 | 1 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | not published | not published | $23.65 – $55.97 | 4 |
| M.avium-intra dna amp prob CPT 87561 | $80.85 | $147.00 | $35.09 – $71.00 | 4 |
| M.avium-intra dna dir prob CPT 87560 | not published | not published | $27.29 – $47.76 | 4 |
| M.avium-intra dna quant CPT 87562 | not published | not published | $42.84 – $86.68 | 4 |
| Maxillofacial fixation CPT 21100 | not published | not published | $4,428.00 – $16,106.00 | 3 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $117.70 | $214.00 | $14.46 – $29.27 | 4 |
| Mayo aathr protein s free CPT 85306 | $124.30 | $226.00 | $15.32 – $28.91 | 4 |
| Mayo activated protein c resistance assay CPT 85307 | $94.05 | $171.00 | $15.32 – $28.91 | 4 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | $63.80 | $116.00 | $38.57 – $67.50 | 4 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $194.15 | $353.00 | not published | 0 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $194.70 | $354.00 | $35.06 – $35.06 | 1 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $77.00 | $140.00 | $14.78 – $29.93 | 4 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $33.00 | $60.00 | $35.06 – $35.06 | 1 |
| Mayo alpha 1 antitrypsin CPT 82103 | $119.90 | $218.00 | $13.44 – $27.18 | 4 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $138.05 | $251.00 | $15.08 – $30.50 | 4 |
| Mayo amphu amphetamines definitive assay 3 or 4 urine CPT 80325 | $82.50 | $150.00 | not published | 0 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $188.65 | $343.00 | $35.06 – $35.06 | 1 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $333.85 | $607.00 | $121.63 – $246.12 | 4 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $508.20 | $924.00 | $91.66 – $185.50 | 4 |
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.