Dartmouth-Hitchcock Medical Center

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $7,671

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $4,529

• Breast MRI

  SSP RA011

  up to

  $7,805

• Breast Ultrasound

  SSP RA012

  up to

  $676

• Bronchoscopy

  SSP PU000

  up to

  $4,935

• Carpal Tunnel Repair

  SSP NU002

  up to

  $8,420

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $11,912

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $2,877

• Colonoscopy

  SSP GA002

  up to

  $4,775

• Colonoscopy via Stoma

  SSP GA000

  up to

  $6,246

• CT

  SSP RA001

  up to

  $1,981

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $2,076

• Delivery - Cesarean

  SSP OB002

  up to

  $34,042

• Delivery - Vaginal

  SSP OB001

  up to

  $22,115

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $4,354

• Fetal MRI

  SSP RA006

  up to

  $1,370

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $2,676

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $1,548

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $14,567

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $14,626

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $14,777

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $12,911

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $10,350

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $11,688

• Mammogram

  SSP RA010

  up to

  $790

• MRI with Contrast

  SSP RA007

  up to

  $1,970

• MRI without Contrast

  SSP RA005

  up to

  $1,458

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $7,462

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $13,700

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $7,436

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $11,337

• Ultrasound

  SSP RA008

  up to

  $641

• X-Ray

  SSP RA000

  up to

  $591