Alice Hyde Medical Center

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $9,518

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $9,399

• Breast MRI

  SSP RA011

  up to

  $2,611

• Breast Ultrasound

  SSP RA012

  up to

  $625

• Bronchoscopy

  SSP PU000

  up to

  $10,745

• Carpal Tunnel Repair

  SSP NU002

  up to

  $9,471

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $9,602

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $9,378

• Colonoscopy

  SSP GA002

  up to

  $10,029

• Colonoscopy via Stoma

  SSP GA000

  up to

  $9,637

• CT

  SSP RA001

  up to

  $3,663

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $7,268

• Delivery - Cesarean

  SSP OB002

  up to

  $33,867

• Delivery - Vaginal

  SSP OB001

  up to

  $20,782

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $9,219

• Fetal MRI

  SSP RA006

  up to

  $1,037

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $9,104

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $9,485

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $9,546

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $11,448

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $9,440

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $10,086

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $9,598

• Mammogram

  SSP RA010

  up to

  $795

• MRI with Contrast

  SSP RA007

  up to

  $5,635

• MRI without Contrast

  SSP RA005

  up to

  $5,359

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $9,700

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $10,937

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $9,251

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $9,264

• Ultrasound

  SSP RA008

  up to

  $1,046

• X-Ray

  SSP RA000

  up to

  $1,202