Addison Gilbert Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $6,062

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $2,757

• Breast MRI

  SSP RA011

  up to

  $855

• Breast Ultrasound

  SSP RA012

  up to

  $434

• Bronchoscopy

  SSP PU000

  up to

  $6,561

• Carpal Tunnel Repair

  SSP NU002

  up to

  $5,972

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $5,271

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $2,926

• Colonoscopy

  SSP GA002

  up to

  $5,417

• Colonoscopy via Stoma

  SSP GA000

  up to

  $5,029

• CT

  SSP RA001

  up to

  $878

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $911

• Delivery - Cesarean

  SSP OB002

  up to

  $9,116

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $4,180

• Fetal MRI

  SSP RA006

  up to

  $691

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $2,608

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $2,853

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $8,057

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $6,128

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $11,034

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $7,307

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $6,949

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $8,260

• MRI with Contrast

  SSP RA007

  up to

  $812

• MRI without Contrast

  SSP RA005

  up to

  $854

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $4,127

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $10,246

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $4,645

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $4,753

• Ultrasound

  SSP RA008

  up to

  $387

• X-Ray

  SSP RA000

  up to

  $313