Diley Ridge Medical Center

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $7,011

• Breast MRI

  SSP RA011

  up to

  $1,014

• Breast Ultrasound

  SSP RA012

  up to

  $652

• Bronchoscopy

  SSP PU000

  up to

  $5,816

• Carpal Tunnel Repair

  SSP NU002

  up to

  $2,214

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $2,269

• Colonoscopy

  SSP GA002

  up to

  $3,109

• Colonoscopy via Stoma

  SSP GA000

  up to

  $1,690

• CT

  SSP RA001

  up to

  $1,401

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $1,264

• Delivery - Cesarean

  SSP OB002

  up to

  $34,525

• Delivery - Vaginal

  SSP OB001

  up to

  $22,429

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $1,991

• Fetal MRI

  SSP RA006

  up to

  $386

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $2,495

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $997

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $7,529

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $5,079

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $14,728

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $4,479

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $6,362

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $10,578

• Mammogram

  SSP RA010

  up to

  $385

• MRI with Contrast

  SSP RA007

  up to

  $1,977

• MRI without Contrast

  SSP RA005

  up to

  $1,908

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $4,411

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $10,809

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $2,491

• Ultrasound

  SSP RA008

  up to

  $1,111

• X-Ray

  SSP RA000

  up to

  $572