West Tennessee Healthcare Bolivar Hospital

Provider Information

Services

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $2,489

• Breast MRI

  SSP RA011

  up to

  $2,015

• Breast Ultrasound

  SSP RA012

  up to

  $642

• Bronchoscopy

  SSP PU000

  up to

  $5,842

• Carpal Tunnel Repair

  SSP NU002

  up to

  $4,623

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $6,140

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $3,914

• Colonoscopy

  SSP GA002

  up to

  $4,520

• CT

  SSP RA001

  up to

  $4,227

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $2,799

• Delivery - Cesarean

  SSP OB002

  up to

  $14,140

• Delivery - Vaginal

  SSP OB001

  up to

  $9,186

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $4,820

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,630

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $1,572

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $17,819

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $22,568

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $10,004

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $10,032

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $12,348

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $26,011

• Mammogram

  SSP RA010

  up to

  $603

• MRI with Contrast

  SSP RA007

  up to

  $1,456

• MRI without Contrast

  SSP RA005

  up to

  $3,258

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $8,422

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $11,519

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $10,898

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $10,185

• Ultrasound

  SSP RA008

  up to

  $1,057

• X-Ray

  SSP RA000

  up to

  $726