Wentworth-Douglass Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $9,410

• Breast MRI

  SSP RA011

  up to

  $7,096

• Breast Ultrasound

  SSP RA012

  up to

  $745

• Bronchoscopy

  SSP PU000

  up to

  $4,885

• Carpal Tunnel Repair

  SSP NU002

  up to

  $3,861

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $7,136

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $5,439

• Colonoscopy

  SSP GA002

  up to

  $4,653

• Colonoscopy via Stoma

  SSP GA000

  up to

  $5,408

• CT

  SSP RA001

  up to

  $4,221

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $5,145

• Delivery - Cesarean

  SSP OB002

  up to

  $34,581

• Delivery - Vaginal

  SSP OB001

  up to

  $22,466

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $3,685

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $2,158

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $2,208

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $16,265

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $9,480

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $15,950

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $12,672

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $10,805

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $13,259

• Mammogram

  SSP RA010

  up to

  $1,122

• MRI with Contrast

  SSP RA007

  up to

  $5,193

• MRI without Contrast

  SSP RA005

  up to

  $5,234

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $5,652

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $11,231

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $9,080

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $8,923

• Ultrasound

  SSP RA008

  up to

  $1,125

• X-Ray

  SSP RA000

  up to

  $582