Gundersen Palmer Lutheran Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $13,044

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $3,398

• Breast MRI

  SSP RA011

  up to

  $1,514

• Breast Ultrasound

  SSP RA012

  up to

  $411

• Bronchoscopy

  SSP PU000

  up to

  $19,256

• Carpal Tunnel Repair

  SSP NU002

  up to

  $4,344

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $4,897

• Colonoscopy

  SSP GA002

  up to

  $5,656

• Colonoscopy via Stoma

  SSP GA000

  up to

  $1,909

• CT

  SSP RA001

  up to

  $1,411

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $2,196

• Delivery - Cesarean

  SSP OB002

  up to

  $8,447

• Delivery - Vaginal

  SSP OB001

  up to

  $9,889

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $3,684

• Fetal MRI

  SSP RA006

  up to

  $2,091

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $935

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $2,448

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $9,323

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $7,956

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $7,917

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $7,026

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $8,277

• Mammogram

  SSP RA010

  up to

  $389

• MRI with Contrast

  SSP RA007

  up to

  $2,051

• MRI without Contrast

  SSP RA005

  up to

  $2,376

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $2,945

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $15,371

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $3,780

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $4,291

• Ultrasound

  SSP RA008

  up to

  $561

• X-Ray

  SSP RA000

  up to

  $326