IU Health White Memorial Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $7,480

• Breast MRI

  SSP RA011

  up to

  $1,220

• Breast Ultrasound

  SSP RA012

  up to

  $511

• Bronchoscopy

  SSP PU000

  up to

  $6,471

• Carpal Tunnel Repair

  SSP NU002

  up to

  $4,025

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $4,220

• Colonoscopy

  SSP GA002

  up to

  $4,294

• Colonoscopy via Stoma

  SSP GA000

  up to

  $2,922

• CT

  SSP RA001

  up to

  $1,621

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $4,821

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $4,320

• Fetal MRI

  SSP RA006

  up to

  $914

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $3,101

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $5,778

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $9,512

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $9,043

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $16,777

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $8,138

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $9,454

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $12,349

• Mammogram

  SSP RA010

  up to

  $847

• MRI with Contrast

  SSP RA007

  up to

  $2,979

• MRI without Contrast

  SSP RA005

  up to

  $1,845

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $6,777

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $13,750

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $3,972

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $4,478

• Ultrasound

  SSP RA008

  up to

  $2,318

• X-Ray

  SSP RA000

  up to

  $854