Grant Memorial Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $943

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $601

• Breast MRI

  SSP RA011

  up to

  $3,132

• Breast Ultrasound

  SSP RA012

  up to

  $247

• Bronchoscopy

  SSP PU000

  up to

  $258

• Carpal Tunnel Repair

  SSP NU002

  up to

  $865

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $1,112

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $1,654

• Colonoscopy

  SSP GA002

  up to

  $758

• Colonoscopy via Stoma

  SSP GA000

  up to

  $1,384

• CT

  SSP RA001

  up to

  $1,593

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $1,935

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $504

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,086

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $554

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $1,015

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $3,674

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $1,285

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $3,355

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $5,136

• Mammogram

  SSP RA010

  up to

  $228

• MRI with Contrast

  SSP RA007

  up to

  $1,513

• MRI without Contrast

  SSP RA005

  up to

  $923

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $2,626

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $4,654

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $469

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $489

• Ultrasound

  SSP RA008

  up to

  $247

• X-Ray

  SSP RA000

  up to

  $440