Guthrie Lourdes Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $19,573

• Breast MRI

  SSP RA011

  up to

  $944

• Breast Ultrasound

  SSP RA012

  up to

  $223

• Bronchoscopy

  SSP PU000

  up to

  $14,186

• Carpal Tunnel Repair

  SSP NU002

  up to

  $13,875

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $17,472

• Colonoscopy

  SSP GA002

  up to

  $16,379

• Colonoscopy via Stoma

  SSP GA000

  up to

  $1,055

• CT

  SSP RA001

  up to

  $2,851

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $560

• Delivery - Cesarean

  SSP OB002

  up to

  $17,467

• Delivery - Vaginal

  SSP OB001

  up to

  $12,162

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $10,015

• Fetal MRI

  SSP RA006

  up to

  $807

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $3,135

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $887

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $75,781

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $6,076

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $16,606

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $24,590

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $18,836

• Mammogram

  SSP RA010

  up to

  $724

• MRI with Contrast

  SSP RA007

  up to

  $839

• MRI without Contrast

  SSP RA005

  up to

  $549

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $6,558

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $31,273

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $9,625

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $18,588

• Ultrasound

  SSP RA008

  up to

  $2,248

• X-Ray

  SSP RA000

  up to

  $1,149