Boston Childrens Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $6,278

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $2,317

• Breast MRI

  SSP RA011

  up to

  $2,413

• Breast Ultrasound

  SSP RA012

  up to

  $726

• Bronchoscopy

  SSP PU000

  up to

  $3,991

• Carpal Tunnel Repair

  SSP NU002

  up to

  $6,297

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $6,146

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $3,501

• Colonoscopy

  SSP GA002

  up to

  $5,465

• Colonoscopy via Stoma

  SSP GA000

  up to

  $3,631

• CT

  SSP RA001

  up to

  $4,127

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $5,027

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $3,301

• Fetal MRI

  SSP RA006

  up to

  $2,734

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $751

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $3,603

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $13,727

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $10,510

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $25,863

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $10,668

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $10,887

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $15,303

• Mammogram

  SSP RA010

  up to

  $702

• MRI with Contrast

  SSP RA007

  up to

  $6,549

• MRI without Contrast

  SSP RA005

  up to

  $4,605

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $4,980

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $17,819

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $10,270

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $8,029

• Ultrasound

  SSP RA008

  up to

  $1,821

• X-Ray

  SSP RA000

  up to

  $1,247