IU Health Jay Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $8,284

• Breast MRI

  SSP RA011

  up to

  $1,481

• Breast Ultrasound

  SSP RA012

  up to

  $611

• Bronchoscopy

  SSP PU000

  up to

  $7,932

• Carpal Tunnel Repair

  SSP NU002

  up to

  $4,438

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $4,654

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $1,216

• Colonoscopy

  SSP GA002

  up to

  $5,318

• Colonoscopy via Stoma

  SSP GA000

  up to

  $3,221

• CT

  SSP RA001

  up to

  $1,968

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $2,556

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $5,275

• Fetal MRI

  SSP RA006

  up to

  $1,075

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $3,795

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $7,061

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $10,551

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $8,142

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $18,446

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $6,967

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $10,472

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $11,570

• Mammogram

  SSP RA010

  up to

  $1,254

• MRI with Contrast

  SSP RA007

  up to

  $3,642

• MRI without Contrast

  SSP RA005

  up to

  $2,251

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $8,258

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $12,223

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $4,399

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $4,966

• Ultrasound

  SSP RA008

  up to

  $2,830

• X-Ray

  SSP RA000

  up to

  $1,049