Memorial Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $14,208

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $1,188

• Breast MRI

  SSP RA011

  up to

  $2,369

• Breast Ultrasound

  SSP RA012

  up to

  $1,058

• Bronchoscopy

  SSP PU000

  up to

  $7,220

• Carpal Tunnel Repair

  SSP NU002

  up to

  $3,493

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $11,101

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $1,472

• Colonoscopy

  SSP GA002

  up to

  $5,908

• Colonoscopy via Stoma

  SSP GA000

  up to

  $5,299

• CT

  SSP RA001

  up to

  $1,969

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $2,550

• Delivery - Cesarean

  SSP OB002

  up to

  $34,137

• Delivery - Vaginal

  SSP OB001

  up to

  $12,166

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $4,654

• Fetal MRI

  SSP RA006

  up to

  $699

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $3,970

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $1,899

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $37,902

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $30,551

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $15,088

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $13,184

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $19,365

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $19,388

• Mammogram

  SSP RA010

  up to

  $785

• MRI with Contrast

  SSP RA007

  up to

  $2,206

• MRI without Contrast

  SSP RA005

  up to

  $1,994

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $6,653

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $35,221

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $14,571

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $13,159

• Ultrasound

  SSP RA008

  up to

  $1,042

• X-Ray

  SSP RA000

  up to

  $818