Three Rivers Medical Center

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $24,828

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $2,084

• Breast MRI

  SSP RA011

  up to

  $1,553

• Breast Ultrasound

  SSP RA012

  up to

  $621

• Bronchoscopy

  SSP PU000

  up to

  $5,545

• Carpal Tunnel Repair

  SSP NU002

  up to

  $13,002

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $11,955

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $3,928

• Colonoscopy

  SSP GA002

  up to

  $6,851

• Colonoscopy via Stoma

  SSP GA000

  up to

  $5,428

• CT

  SSP RA001

  up to

  $4,165

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $6,641

• Delivery - Cesarean

  SSP OB002

  up to

  $39,158

• Delivery - Vaginal

  SSP OB001

  up to

  $33,092

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $10,155

• Fetal MRI

  SSP RA006

  up to

  $612

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,761

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $997

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $20,537

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $23,003

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $32,989

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $24,480

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $28,351

• Mammogram

  SSP RA010

  up to

  $734

• MRI with Contrast

  SSP RA007

  up to

  $8,583

• MRI without Contrast

  SSP RA005

  up to

  $6,707

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $5,302

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $37,125

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $16,342

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $17,551

• Ultrasound

  SSP RA008

  up to

  $2,280

• X-Ray

  SSP RA000

  up to

  $2,628