Shriners Childrens Ohio

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $2,895

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $1,712

• Breast MRI

  SSP RA011

  up to

  $2,049

• Breast Ultrasound

  SSP RA012

  up to

  $725

• Bronchoscopy

  SSP PU000

  up to

  $4,654

• Carpal Tunnel Repair

  SSP NU002

  up to

  $2,839

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $2,800

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $1,606

• Colonoscopy

  SSP GA002

  up to

  $3,240

• Colonoscopy via Stoma

  SSP GA000

  up to

  $2,965

• CT

  SSP RA001

  up to

  $1,088

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $1,071

• Delivery - Cesarean

  SSP OB002

  up to

  $16,739

• Delivery - Vaginal

  SSP OB001

  up to

  $11,655

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $2,213

• Fetal MRI

  SSP RA006

  up to

  $845

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,282

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $1,874

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $3,586

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $2,789

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $20,210

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $13,315

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $2,982

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $3,970

• Mammogram

  SSP RA010

  up to

  $472

• MRI with Contrast

  SSP RA007

  up to

  $1,489

• MRI without Contrast

  SSP RA005

  up to

  $1,689

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $2,432

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $19,215

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $5,355

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $2,354

• Ultrasound

  SSP RA008

  up to

  $939

• X-Ray

  SSP RA000

  up to

  $266