Grandview Medical Center

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $28,769

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $18,802

• Breast MRI

  SSP RA011

  up to

  $2,072

• Breast Ultrasound

  SSP RA012

  up to

  $284

• Bronchoscopy

  SSP PU000

  up to

  $19,863

• Carpal Tunnel Repair

  SSP NU002

  up to

  $14,095

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $17,903

• Colonoscopy

  SSP GA002

  up to

  $8,780

• Colonoscopy via Stoma

  SSP GA000

  up to

  $6,761

• CT

  SSP RA001

  up to

  $3,497

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $6,150

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $7,331

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $3,861

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $7,452

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $21,403

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $30,068

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $32,288

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $17,469

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $30,198

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $20,926

• Mammogram

  SSP RA010

  up to

  $218

• MRI with Contrast

  SSP RA007

  up to

  $2,483

• MRI without Contrast

  SSP RA005

  up to

  $1,671

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $6,002

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $32,630

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $14,176

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $11,903

• Ultrasound

  SSP RA008

  up to

  $593

• X-Ray

  SSP RA000

  up to

  $730