Dominican Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $10,609

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $4,481

• Breast MRI

  SSP RA011

  up to

  $10,693

• Breast Ultrasound

  SSP RA012

  up to

  $1,474

• Bronchoscopy

  SSP PU000

  up to

  $7,958

• Carpal Tunnel Repair

  SSP NU002

  up to

  $10,563

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $8,736

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $5,368

• Colonoscopy

  SSP GA002

  up to

  $6,902

• Colonoscopy via Stoma

  SSP GA000

  up to

  $6,729

• CT

  SSP RA001

  up to

  $7,034

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $1,017

• Delivery - Cesarean

  SSP OB002

  up to

  $29,200

• Delivery - Vaginal

  SSP OB001

  up to

  $15,977

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $6,455

• Fetal MRI

  SSP RA006

  up to

  $3,583

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,902

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $4,555

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $15,811

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $10,674

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $17,697

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $12,510

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $11,165

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $15,944

• Mammogram

  SSP RA010

  up to

  $1,043

• MRI with Contrast

  SSP RA007

  up to

  $9,835

• MRI without Contrast

  SSP RA005

  up to

  $7,046

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $6,563

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $17,197

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $8,348

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $8,384

• Ultrasound

  SSP RA008

  up to

  $2,531

• X-Ray

  SSP RA000

  up to

  $1,799