Western Wisconsin Health

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $8,149

• Breast MRI

  SSP RA011

  up to

  $2,856

• Breast Ultrasound

  SSP RA012

  up to

  $623

• Bronchoscopy

  SSP PU000

  up to

  $7,520

• Carpal Tunnel Repair

  SSP NU002

  up to

  $3,330

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $3,455

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $1,478

• Colonoscopy

  SSP GA002

  up to

  $6,691

• Colonoscopy via Stoma

  SSP GA000

  up to

  $2,746

• CT

  SSP RA001

  up to

  $3,290

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $3,785

• Delivery - Cesarean

  SSP OB002

  up to

  $8,957

• Delivery - Vaginal

  SSP OB001

  up to

  $7,714

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $5,862

• Fetal MRI

  SSP RA006

  up to

  $1,093

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $602

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $1,141

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $6,756

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $4,976

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $14,680

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $8,932

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $8,035

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $10,594

• Mammogram

  SSP RA010

  up to

  $657

• MRI with Contrast

  SSP RA007

  up to

  $4,962

• MRI without Contrast

  SSP RA005

  up to

  $3,369

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $3,230

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $12,009

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $6,960

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $8,314

• Ultrasound

  SSP RA008

  up to

  $1,006

• X-Ray

  SSP RA000

  up to

  $499