Johnson Memorial Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $11,658

• Breast MRI

  SSP RA011

  up to

  $1,841

• Breast Ultrasound

  SSP RA012

  up to

  $345

• Bronchoscopy

  SSP PU000

  up to

  $6,958

• Carpal Tunnel Repair

  SSP NU002

  up to

  $6,102

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $6,540

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $3,114

• Colonoscopy

  SSP GA002

  up to

  $6,208

• Colonoscopy via Stoma

  SSP GA000

  up to

  $4,241

• CT

  SSP RA001

  up to

  $651

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $863

• Delivery - Cesarean

  SSP OB002

  up to

  $18,839

• Delivery - Vaginal

  SSP OB001

  up to

  $12,239

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $5,124

• Fetal MRI

  SSP RA006

  up to

  $615

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,320

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $719

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $21,236

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $12,595

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $25,788

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $9,917

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $14,682

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $21,580

• Mammogram

  SSP RA010

  up to

  $452

• MRI with Contrast

  SSP RA007

  up to

  $784

• MRI without Contrast

  SSP RA005

  up to

  $628

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $4,369

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $16,761

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $7,413

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $7,687

• Ultrasound

  SSP RA008

  up to

  $486

• X-Ray

  SSP RA000

  up to

  $383