Montgomery General Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $4,788

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $4,903

• Breast MRI

  SSP RA011

  up to

  $4,336

• Breast Ultrasound

  SSP RA012

  up to

  $736

• Bronchoscopy

  SSP PU000

  up to

  $6,505

• Carpal Tunnel Repair

  SSP NU002

  up to

  $5,431

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $4,079

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $4,641

• Colonoscopy

  SSP GA002

  up to

  $3,221

• Colonoscopy via Stoma

  SSP GA000

  up to

  $3,042

• CT

  SSP RA001

  up to

  $2,983

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $1,989

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $2,814

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $3,170

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $1,226

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $18,574

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $19,266

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $6,287

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $15,417

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $10,203

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $20,422

• Mammogram

  SSP RA010

  up to

  $290

• MRI with Contrast

  SSP RA007

  up to

  $2,976

• MRI without Contrast

  SSP RA005

  up to

  $2,439

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $5,944

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $41,945

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $10,410

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $8,089

• Ultrasound

  SSP RA008

  up to

  $784

• X-Ray

  SSP RA000

  up to

  $656