OHSU Doernbecher Childrens Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $6,591

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $2,961

• Breast MRI

  SSP RA011

  up to

  $3,840

• Breast Ultrasound

  SSP RA012

  up to

  $702

• Bronchoscopy

  SSP PU000

  up to

  $3,787

• Carpal Tunnel Repair

  SSP NU002

  up to

  $4,464

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $5,646

• Colonoscopy

  SSP GA002

  up to

  $2,527

• Colonoscopy via Stoma

  SSP GA000

  up to

  $2,527

• CT

  SSP RA001

  up to

  $3,771

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $3,357

• Delivery - Cesarean

  SSP OB002

  up to

  $35,273

• Delivery - Vaginal

  SSP OB001

  up to

  $28,570

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $1,939

• Fetal MRI

  SSP RA006

  up to

  $818

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,897

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $897

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $14,442

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $9,826

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $8,123

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $9,023

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $7,619

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $9,058

• Mammogram

  SSP RA010

  up to

  $348

• MRI with Contrast

  SSP RA007

  up to

  $5,246

• MRI without Contrast

  SSP RA005

  up to

  $3,213

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $3,680

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $12,327

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $4,612

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $5,410

• Ultrasound

  SSP RA008

  up to

  $828

• X-Ray

  SSP RA000

  up to

  $559