Deaconess Gateway Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $1,120

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $314

• Breast MRI

  SSP RA011

  up to

  $1,493

• Breast Ultrasound

  SSP RA012

  up to

  $353

• Bronchoscopy

  SSP PU000

  up to

  $405

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $1,378

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $418

• Colonoscopy

  SSP GA002

  up to

  $607

• Colonoscopy via Stoma

  SSP GA000

  up to

  $505

• CT

  SSP RA001

  up to

  $972

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $1,149

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $455

• Fetal MRI

  SSP RA006

  up to

  $456

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,357

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $452

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $797

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $788

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $1,365

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $2,453

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $1,416

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $1,400

• Mammogram

  SSP RA010

  up to

  $251

• MRI with Contrast

  SSP RA007

  up to

  $1,391

• MRI without Contrast

  SSP RA005

  up to

  $1,377

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $2,371

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $1,739

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $420

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $429

• Ultrasound

  SSP RA008

  up to

  $521

• X-Ray

  SSP RA000

  up to

  $446