West Tennessee Healthcare Bolivar Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $1,295

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $2,104

• Breast MRI

  SSP RA011

  up to

  $1,822

• Breast Ultrasound

  SSP RA012

  up to

  $1,119

• Bronchoscopy

  SSP PU000

  up to

  $1,570

• Carpal Tunnel Repair

  SSP NU002

  up to

  $1,344

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $1,327

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $3,673

• Colonoscopy

  SSP GA002

  up to

  $656

• Colonoscopy via Stoma

  SSP GA000

  up to

  $658

• CT

  SSP RA001

  up to

  $3,980

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $2,616

• Delivery - Cesarean

  SSP OB002

  up to

  $3,831

• Delivery - Vaginal

  SSP OB001

  up to

  $2,772

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $3,018

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,593

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $3,647

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $5,111

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $3,915

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $2,457

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $1,877

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $2,196

• Mammogram

  SSP RA010

  up to

  $512

• MRI with Contrast

  SSP RA007

  up to

  $3,502

• MRI without Contrast

  SSP RA005

  up to

  $2,766

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $4,138

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $2,262

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $1,724

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $2,128

• Ultrasound

  SSP RA008

  up to

  $1,238

• X-Ray

  SSP RA000

  up to

  $782