Ambulatory Care Center

Provider Information

Services

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $1,504

• Breast MRI

  SSP RA011

  up to

  $248

• Bronchoscopy

  SSP PU000

  up to

  $1,750

• Carpal Tunnel Repair

  SSP NU002

  up to

  $1,513

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $2,089

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $1,350

• Colonoscopy

  SSP GA002

  up to

  $1,253

• Colonoscopy via Stoma

  SSP GA000

  up to

  $1,164

• CT

  SSP RA001

  up to

  $464

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $466

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $754

• Fetal MRI

  SSP RA006

  up to

  $322

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $523

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $560

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $3,974

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $2,542

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $7,187

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $4,210

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $3,159

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $4,270

• MRI with Contrast

  SSP RA007

  up to

  $414

• MRI without Contrast

  SSP RA005

  up to

  $364

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $1,071

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $6,459

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $3,873

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $2,016

• Ultrasound

  SSP RA008

  up to

  $179

• X-Ray

  SSP RA000

  up to

  $111