Methodist West Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $2,805

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $1,203

• Breast MRI

  SSP RA011

  up to

  $626

• Breast Ultrasound

  SSP RA012

  up to

  $523

• Bronchoscopy

  SSP PU000

  up to

  $2,226

• Carpal Tunnel Repair

  SSP NU002

  up to

  $2,512

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $3,725

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $2,572

• Colonoscopy

  SSP GA002

  up to

  $1,844

• Colonoscopy via Stoma

  SSP GA000

  up to

  $1,045

• CT

  SSP RA001

  up to

  $721

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $790

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $3,997

• Fetal MRI

  SSP RA006

  up to

  $864

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,575

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $434

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $2,742

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $3,098

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $1,117

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $3,408

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $3,251

• Mammogram

  SSP RA010

  up to

  $327

• MRI with Contrast

  SSP RA007

  up to

  $1,178

• MRI without Contrast

  SSP RA005

  up to

  $3,198

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $4,488

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $5,272

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $715

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $746

• Ultrasound

  SSP RA008

  up to

  $374

• X-Ray

  SSP RA000

  up to

  $194