Adams Memorial Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $8,888

• Breast MRI

  SSP RA011

  up to

  $2,815

• Breast Ultrasound

  SSP RA012

  up to

  $920

• Bronchoscopy

  SSP PU000

  up to

  $3,201

• Carpal Tunnel Repair

  SSP NU002

  up to

  $4,658

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $4,026

• Colonoscopy

  SSP GA002

  up to

  $7,328

• Colonoscopy via Stoma

  SSP GA000

  up to

  $3,249

• CT

  SSP RA001

  up to

  $2,306

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $2,951

• Delivery - Cesarean

  SSP OB002

  up to

  $15,390

• Delivery - Vaginal

  SSP OB001

  up to

  $9,196

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $3,902

• Fetal MRI

  SSP RA006

  up to

  $518

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,253

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $742

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $11,470

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $7,932

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $19,703

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $7,559

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $11,195

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $12,444

• Mammogram

  SSP RA010

  up to

  $502

• MRI with Contrast

  SSP RA007

  up to

  $4,188

• MRI without Contrast

  SSP RA005

  up to

  $2,940

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $3,477

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $12,347

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $4,918

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $4,869

• Ultrasound

  SSP RA008

  up to

  $1,260

• X-Ray

  SSP RA000

  up to

  $596