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 |
|---|---|---|---|---|
| Infect ag phenotype na hiv-1 ea addl drg CPT 87904 | not published | not published | $26.07 – $52.74 | 4 |
| Infectious agent antigen immunoassay direct optical observation sars-cov-2 CPT 87811 | not published | not published | $41.48 – $72.42 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin CPT 87324 | $81.40 | $148.00 | $11.98 – $24.26 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans CPT 87327 | not published | not published | $13.42 – $24.26 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step cryptosporidium CPT 87328 | $135.30 | $246.00 | $13.82 – $24.26 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step giardia CPT 87329 | $133.65 | $243.00 | $11.98 – $24.26 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool CPT 87338 | $120.45 | $219.00 | $14.38 – $29.09 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn CPT 87340 | $118.80 | $216.00 | $10.33 – $20.90 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization CPT 87341 | $17.60 | $32.00 | $10.33 – $20.90 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies CPT 87389 | $103.40 | $188.00 | $24.08 – $48.72 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step legionella urine CPT 87449 | $138.05 | $251.00 | $11.98 – $24.26 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step rotavirus CPT 87425 | $89.10 | $162.00 | $11.98 – $24.26 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin CPT 87427 | $89.65 | $163.00 | $11.98 – $24.26 | 4 |
| Infectious agent nucleic acid amplified probe CPT 87798 | $386.10 | $702.00 | $35.09 – $71.00 | 4 |
| Infectious agent nucleic acid amplified probe chlamydia trachomatis CPT 87491 | $265.10 | $482.00 | $35.09 – $71.00 | 4 |
| Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s) CPT 87493 | $80.85 | $147.00 | $37.27 – $71.00 | 4 |
| Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets CPT 87483 | $930.05 | $1,691.00 | $416.78 – $849.28 | 4 |
| Infectious agent nucleic acid amplified probe hsv-1 CPT 87529 | $376.75 | $685.00 | $35.09 – $71.00 | 4 |
| Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus CPT 87641 | $151.25 | $275.00 | $35.09 – $71.00 | 4 |
| Infectious agent nucleic acid amplified probe mycobacteria tuberculosis CPT 87556 | $92.95 | $169.00 | $41.68 – $72.94 | 4 |
| Infectious agent nucleic acid amplified probe neisseria gonorrhoeae CPT 87591 | $383.35 | $697.00 | $35.09 – $71.00 | 4 |
| Infectious agent nucleic acid amplified probe sars-cov-2/covid-19 CPT 87635 | $115.50 | $210.00 | $51.31 – $89.79 | 4 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b CPT 87636 | $320.65 | $583.00 | $142.60 – $249.60 | 4 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv CPT 87637 | $318.45 | $579.00 | $142.60 – $249.60 | 4 |
| Infectious agent nucleic acid amplified probe streptococcus group a CPT 87651 | not published | not published | $35.09 – $71.00 | 4 |
| Infectious agent nucleic acid amplified probe trichomonas vaginalis CPT 87661 | $80.85 | $147.00 | $35.09 – $71.00 | 4 |
| Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance CPT 87564 | not published | not published | $76.77 – $134.35 | 4 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets CPT 87507 | not published | not published | $416.78 – $843.37 | 4 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets CPT 87505 | not published | not published | $128.29 – $259.61 | 4 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets CPT 87506 | $1,144.55 | $2,081.00 | $262.99 – $460.23 | 4 |
| Infectious agent nucleic acid quantification bk virus CPT 87799 | $279.40 | $508.00 | $42.84 – $86.68 | 4 |
| Infectious agent nucleic acid quantification hepatitis b CPT 87517 | $467.50 | $850.00 | $42.84 – $86.68 | 4 |
| Infectious agent nucleic acid quantification hepatitis c CPT 87522 | $473.00 | $860.00 | $42.84 – $86.68 | 4 |
| Infectious agent nucleic acid quantification hiv-1 CPT 87536 | $189.75 | $345.00 | $85.10 – $172.20 | 4 |
| Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets CPT 87631 | $584.65 | $1,063.00 | $142.63 – $259.61 | 4 |
| Infliximab 100 mg intravenous solution HCPCS J1745 | not published | not published | $33.05 – $83.11 | 5 |
| Infliximab-axxq 100 mg intravenous solution HCPCS Q5121 | not published | not published | $21.73 – $53.99 | 4 |
| Infliximab-dyyb 100 mg intravenous solution HCPCS Q5103 | not published | not published | $17.50 – $37.39 | 4 |
| Influenza dna amp prob addl CPT 87503 | not published | not published | $29.22 – $51.14 | 4 |
| Influenza virus vaccine, inact hemagglutinin tiv pf inj CPT 90673 | not published | not published | $91.84 – $227.30 | 4 |
| Influenza virus vaccine, live trivalent intranasal CPT 90660 | not published | not published | $31.76 – $78.61 | 4 |
| Infratemporal approach/skull CPT 61591 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Infratemporal approach/skull CPT 61590 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Inf thrc fascial pln blk bi w/wo image CPT 64469 | not published | not published | $5,512.00 – $5,512.00 | 1 |
| Inf thrc fascial pln blk uni w/wo image CPT 64467 | not published | not published | $5,512.00 – $5,512.00 | 1 |
| Infuse radioactive materials CPT 77750 | not published | not published | $377.10 – $377.10 | 1 |
| Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis CPT 94642 | $237.60 | $432.00 | not published | 0 |
| Initiation & management bipap/cpap initial day CPT 94660 | $231.55 | $421.00 | not published | 0 |
| Inj, abilify asimtufii, 1 mg HCPCS J0402 | not published | not published | $6.40 – $16.12 | 5 |
| Inj, abilify maintena, 1 mg HCPCS J0401 | not published | not published | $7.65 – $19.26 | 5 |
| Inj acetaminoph 10mg/ibu 3mg HCPCS J0138 | not published | not published | $0.24 – $0.76 | 3 |
| Inj, acetaminophen (b braun) HCPCS J0136 | not published | not published | $0.06 – $0.13 | 5 |
| Inj acetaminophen -fresenius HCPCS J0134 | not published | not published | $0.05 – $0.12 | 5 |
| Inj, acetaminophen (hikma) HCPCS J0137 | not published | not published | $0.03 – $0.13 | 5 |
| Inj. acthar gel to 40 units HCPCS J0801 | not published | not published | $4,144.48 – $10,421.27 | 5 |
| Inj, adalimumab, 1 mg HCPCS J0139 | not published | not published | $249.73 – $249.73 | 1 |
| Inj adalimumab-ryvk, 1 mg HCPCS Q5142 | not published | not published | $28.69 – $28.69 | 1 |
| Inj, adstiladrin, per tx dos HCPCS J9029 | not published | not published | $68,646.98 – $172,612.06 | 5 |
| Inj, aducanumab-avwa, 2 mg HCPCS J0172 | not published | not published | $6.47 – $16.29 | 5 |
| Inj, adzynma, 10 iu HCPCS J7171 | not published | not published | $37.43 – $94.12 | 5 |
| Inj, aflibercept-ayyh, 1 mg HCPCS Q5147 | not published | not published | $875.45 – $1,651.26 | 2 |
| Inj, aflibercept hd, 1 mg HCPCS J0177 | not published | not published | $353.30 – $895.87 | 5 |
| Inj, afstyla, 1 i.u HCPCS J7210 | not published | not published | $1.64 – $4.14 | 5 |
| Inj, alfentanil hcl, 500mcg HCPCS J0216 | not published | not published | $12.31 – $12.31 | 1 |
| Inj allopurinol sodium 1 mg HCPCS J0206 | not published | not published | $4.75 – $11.98 | 5 |
| Inj, alyglo, 500 mg HCPCS J1552 | not published | not published | $151.92 – $399.91 | 5 |
| Inj alymsys 10 mg HCPCS Q5126 | not published | not published | $50.66 – $158.53 | 4 |
| Inj, amisulpride, 1 mg HCPCS J0184 | not published | not published | $24.72 – $24.72 | 1 |
| Inj andexxa, 10 mg HCPCS J7169 | not published | not published | $358.83 – $358.83 | 1 |
| Inj anifrolumab-fnia 1mg HCPCS J0491 | not published | not published | $19.23 – $48.35 | 5 |
| Inj. (ani), up to 40 units HCPCS J0802 | not published | not published | $3,755.81 – $9,443.94 | 5 |
| Inj, aponvie, 1 mg HCPCS C9145 | not published | not published | $5.07 – $5.07 | 1 |
| Inj., aristada initio, 1 mg HCPCS J1943 | not published | not published | $3.39 – $8.51 | 5 |
| Inj, artesunate, 1mg HCPCS J0391 | not published | not published | $141.11 – $141.11 | 1 |
| Inj. asceniv HCPCS J1554 | not published | not published | $535.92 – $1,347.56 | 5 |
| Inj, aspara, rylaze, 0.1 mg HCPCS J9021 | not published | not published | $58.62 – $147.39 | 5 |
| Inj atezolizumb 5mg hya-tqjs HCPCS J9024 | not published | not published | $33.97 – $60.11 | 2 |
| Inj avacincaptad pegol 0.1mg HCPCS J2782 | not published | not published | $117.70 – $295.94 | 5 |
| Inj aval alfa-nqpt 4mg HCPCS J0219 | not published | not published | $84.30 – $211.98 | 5 |
| Inj belantamab mafodot blmf HCPCS J9037 | not published | not published | $113.60 – $113.60 | 1 |
| Inj., benralizumab, 1 mg HCPCS J0517 | not published | not published | $179.62 – $451.64 | 5 |
| Inj beta interferon sq 1 mcg HCPCS Q3028 | not published | not published | $127.58 – $127.58 | 1 |
| Inj, betibeglogene autotemce HCPCS J3393 | not published | not published | $8,080,380.00 – $8,080,380.00 | 1 |
| Inj, bezlotoxumab, 10 mg HCPCS J0565 | not published | not published | $43.16 – $108.55 | 5 |
| Inj bimatoprost itc imp1mcg HCPCS J7351 | not published | not published | $227.25 – $571.43 | 5 |
| Inj, biorphen, 20 micrograms HCPCS J2372 | not published | not published | $0.18 – $0.46 | 5 |
| Inj, bortezomib, dr. reddy's HCPCS J9046 | not published | not published | $13.37 – $13.37 | 1 |
| Inj, bortezomib freseniuskab HCPCS J9048 | not published | not published | $44.93 – $44.93 | 1 |
| Inj, bortezomib, hospira HCPCS J9049 | not published | not published | $1.56 – $3.93 | 5 |
| Inj., brexanolone, 1 mg HCPCS J1632 | not published | not published | $243.39 – $243.39 | 1 |
| Inj, brixadi, 7 days or less HCPCS J0577 | not published | not published | $464.11 – $1,167.03 | 5 |
| Inj brixadi, more than 7 day HCPCS J0578 | not published | not published | $1,856.47 – $4,668.08 | 5 |
| Inj, brolucizumab-dbll, 1 mg HCPCS J0179 | not published | not published | $366.92 – $922.63 | 5 |
| Inj bulking agent anal canal HCPCS L8605 | not published | not published | $2,804.55 – $2,804.55 | 1 |
| Inj, bupivacaine liposome HCPCS J0666 | not published | not published | $1.56 – $3.94 | 5 |
| Inj, bupivacaine (posimir) HCPCS C9144 | not published | not published | $1.37 – $1.37 | 1 |
| Inj. byooviz, 0.1 mg HCPCS Q5124 | not published | not published | $94.13 – $460.65 | 4 |
| Inj calcitriol per 0.1 mcg HCPCS J0636 | not published | not published | $2.92 – $2.92 | 1 |
| Inj, carmustine (accord) HCPCS J9052 | not published | not published | $0.13 – $0.13 | 1 |
| Inj cefazolin sodium, baxter HCPCS J0689 | not published | not published | $1.34 – $3.35 | 5 |
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.