Butler Memorial Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $2,909

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $2,287

• Breast MRI

  SSP RA011

  up to

  $3,083

• Breast Ultrasound

  SSP RA012

  up to

  $566

• Bronchoscopy

  SSP PU000

  up to

  $2,130

• Carpal Tunnel Repair

  SSP NU002

  up to

  $4,562

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $4,994

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $1,692

• Colonoscopy

  SSP GA002

  up to

  $2,733

• Colonoscopy via Stoma

  SSP GA000

  up to

  $1,813

• CT

  SSP RA001

  up to

  $1,759

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $4,034

• Delivery - Cesarean

  SSP OB002

  up to

  $27,289

• Delivery - Vaginal

  SSP OB001

  up to

  $18,515

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $2,019

• Fetal MRI

  SSP RA006

  up to

  $898

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,682

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $1,673

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $4,622

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $4,638

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $11,656

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $4,102

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $3,780

• Mammogram

  SSP RA010

  up to

  $757

• MRI with Contrast

  SSP RA007

  up to

  $3,900

• MRI without Contrast

  SSP RA005

  up to

  $3,096

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $2,002

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $4,440

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $3,554

• Ultrasound

  SSP RA008

  up to

  $1,280

• X-Ray

  SSP RA000

  up to

  $694