St Marys Health System

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $5,456

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $1,747

• Breast MRI

  SSP RA011

  up to

  $2,468

• Breast Ultrasound

  SSP RA012

  up to

  $891

• Bronchoscopy

  SSP PU000

  up to

  $4,429

• Carpal Tunnel Repair

  SSP NU002

  up to

  $1,800

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $7,654

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $1,716

• Colonoscopy

  SSP GA002

  up to

  $2,352

• Colonoscopy via Stoma

  SSP GA000

  up to

  $1,951

• CT

  SSP RA001

  up to

  $833

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $608

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $1,124

• Fetal MRI

  SSP RA006

  up to

  $670

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $706

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $1,364

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $6,517

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $8,075

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $9,221

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $18,164

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $5,970

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $6,639

• Mammogram

  SSP RA010

  up to

  $558

• MRI with Contrast

  SSP RA007

  up to

  $471

• MRI without Contrast

  SSP RA005

  up to

  $770

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $1,822

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $8,757

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $10,263

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $11,977

• Ultrasound

  SSP RA008

  up to

  $887

• X-Ray

  SSP RA000

  up to

  $804