Mountain West Medical Center

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $7,871

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $1,281

• Breast MRI

  SSP RA011

  up to

  $3,629

• Breast Ultrasound

  SSP RA012

  up to

  $1,320

• Bronchoscopy

  SSP PU000

  up to

  $1,209

• Carpal Tunnel Repair

  SSP NU002

  up to

  $3,073

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $2,405

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $1,364

• Colonoscopy

  SSP GA002

  up to

  $4,222

• CT

  SSP RA001

  up to

  $3,064

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $4,019

• Delivery - Cesarean

  SSP OB002

  up to

  $35,197

• Delivery - Vaginal

  SSP OB001

  up to

  $28,290

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $1,945

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $924

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $695

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $5,930

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $5,156

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $14,977

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $6,202

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $8,631

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $11,327

• Mammogram

  SSP RA010

  up to

  $427

• MRI with Contrast

  SSP RA007

  up to

  $3,944

• MRI without Contrast

  SSP RA005

  up to

  $3,541

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $2,729

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $10,572

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $3,153

• Ultrasound

  SSP RA008

  up to

  $1,449

• X-Ray

  SSP RA000

  up to

  $1,138