Eskenazi Health

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $31,344

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $2,140

• Breast MRI

  SSP RA011

  up to

  $1,574

• Breast Ultrasound

  SSP RA012

  up to

  $732

• Bronchoscopy

  SSP PU000

  up to

  $5,158

• Carpal Tunnel Repair

  SSP NU002

  up to

  $16,180

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $10,424

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $5,388

• Colonoscopy

  SSP GA002

  up to

  $1,894

• Colonoscopy via Stoma

  SSP GA000

  up to

  $3,817

• CT

  SSP RA001

  up to

  $1,404

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $2,320

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $1,395

• Fetal MRI

  SSP RA006

  up to

  $1,325

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $2,494

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $1,339

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $40,345

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $27,186

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $66,158

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $26,472

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $39,630

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $43,638

• Mammogram

  SSP RA010

  up to

  $696

• MRI with Contrast

  SSP RA007

  up to

  $1,572

• MRI without Contrast

  SSP RA005

  up to

  $1,594

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $7,550

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $37,310

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $14,381

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $17,094

• Ultrasound

  SSP RA008

  up to

  $1,896

• X-Ray

  SSP RA000

  up to

  $648