OSF Heart of Mary Medical Center

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $20,625

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $2,609

• Breast MRI

  SSP RA011

  up to

  $5,830

• Breast Ultrasound

  SSP RA012

  up to

  $576

• Bronchoscopy

  SSP PU000

  up to

  $4,626

• Carpal Tunnel Repair

  SSP NU002

  up to

  $10,451

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $11,755

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $3,383

• Colonoscopy

  SSP GA002

  up to

  $8,979

• Colonoscopy via Stoma

  SSP GA000

  up to

  $8,560

• CT

  SSP RA001

  up to

  $5,808

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $5,816

• Delivery - Cesarean

  SSP OB002

  up to

  $40,744

• Delivery - Vaginal

  SSP OB001

  up to

  $38,771

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $8,978

• Fetal MRI

  SSP RA006

  up to

  $4,329

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $2,007

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $1,325

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $25,046

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $14,154

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $72,398

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $15,960

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $17,201

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $19,447

• Mammogram

  SSP RA010

  up to

  $676

• MRI with Contrast

  SSP RA007

  up to

  $5,803

• MRI without Contrast

  SSP RA005

  up to

  $4,794

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $5,041

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $71,391

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $10,201

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $9,443

• Ultrasound

  SSP RA008

  up to

  $1,157

• X-Ray

  SSP RA000

  up to

  $1,113