Henry Ford Jackson Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $747

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $455

• Breast MRI

  SSP RA011

  up to

  $482

• Breast Ultrasound

  SSP RA012

  up to

  $138

• Bronchoscopy

  SSP PU000

  up to

  $205

• Carpal Tunnel Repair

  SSP NU002

  up to

  $686

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $2,918

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $514

• Colonoscopy

  SSP GA002

  up to

  $1,478

• Colonoscopy via Stoma

  SSP GA000

  up to

  $1,478

• CT

  SSP RA001

  up to

  $158

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $109

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $232

• Fetal MRI

  SSP RA006

  up to

  $307

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $97

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $399

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $764

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $858

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $8,959

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $613

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $921

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $959

• Mammogram

  SSP RA010

  up to

  $124

• MRI with Contrast

  SSP RA007

  up to

  $160

• MRI without Contrast

  SSP RA005

  up to

  $307

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $235

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $1,427

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $389

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $405

• Ultrasound

  SSP RA008

  up to

  $138

• X-Ray

  SSP RA000

  up to

  $138