IU Health White Memorial Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $8,267

• Breast MRI

  SSP RA011

  up to

  $1,179

• Breast Ultrasound

  SSP RA012

  up to

  $524

• Bronchoscopy

  SSP PU000

  up to

  $7,001

• Carpal Tunnel Repair

  SSP NU002

  up to

  $4,419

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $6,672

• Colonoscopy

  SSP GA002

  up to

  $5,226

• Colonoscopy via Stoma

  SSP GA000

  up to

  $2,998

• CT

  SSP RA001

  up to

  $1,071

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $945

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $4,970

• Fetal MRI

  SSP RA006

  up to

  $1,080

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $3,353

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $6,326

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $10,465

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $10,302

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $18,759

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $6,886

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $10,428

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $11,452

• Mammogram

  SSP RA010

  up to

  $319

• MRI with Contrast

  SSP RA007

  up to

  $1,105

• MRI without Contrast

  SSP RA005

  up to

  $1,208

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $6,890

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $12,439

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $7,281

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $4,935

• Ultrasound

  SSP RA008

  up to

  $645

• X-Ray

  SSP RA000

  up to

  $518