Legacy Emanuel Medical Center

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $1,039

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $715

• Breast MRI

  SSP RA011

  up to

  $2,199

• Breast Ultrasound

  SSP RA012

  up to

  $335

• Bronchoscopy

  SSP PU000

  up to

  $628

• Carpal Tunnel Repair

  SSP NU002

  up to

  $963

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $1,342

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $787

• Colonoscopy

  SSP GA002

  up to

  $878

• Colonoscopy via Stoma

  SSP GA000

  up to

  $788

• CT

  SSP RA001

  up to

  $1,491

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $2,402

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $707

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $822

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $736

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $1,048

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $1,170

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $1,879

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $3,587

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $1,281

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $1,307

• Mammogram

  SSP RA010

  up to

  $389

• MRI with Contrast

  SSP RA007

  up to

  $2,536

• MRI without Contrast

  SSP RA005

  up to

  $1,420

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $885

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $1,973

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $540

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $564

• Ultrasound

  SSP RA008

  up to

  $444

• X-Ray

  SSP RA000

  up to

  $195