The University of Vermont Medical Center

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $2,312

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $1,753

• Breast MRI

  SSP RA011

  up to

  $1,642

• Breast Ultrasound

  SSP RA012

  up to

  $474

• Bronchoscopy

  SSP PU000

  up to

  $4,911

• Carpal Tunnel Repair

  SSP NU002

  up to

  $2,130

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $3,068

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $3,712

• Colonoscopy

  SSP GA002

  up to

  $2,983

• Colonoscopy via Stoma

  SSP GA000

  up to

  $3,435

• CT

  SSP RA001

  up to

  $1,426

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $1,629

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $2,971

• Fetal MRI

  SSP RA006

  up to

  $1,955

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $2,179

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $2,274

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $2,099

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $4,126

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $8,772

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $2,825

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $2,898

• Mammogram

  SSP RA010

  up to

  $725

• MRI with Contrast

  SSP RA007

  up to

  $1,740

• MRI without Contrast

  SSP RA005

  up to

  $2,640

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $7,265

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $4,349

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $1,209

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $890

• Ultrasound

  SSP RA008

  up to

  $798

• X-Ray

  SSP RA000

  up to

  $492