Dominican Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $12,899

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $2,934

• Bronchoscopy

  SSP PU000

  up to

  $12,004

• Carpal Tunnel Repair

  SSP NU002

  up to

  $3,043

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $24,379

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $2,853

• Colonoscopy

  SSP GA002

  up to

  $11,549

• Colonoscopy via Stoma

  SSP GA000

  up to

  $8,775

• CT

  SSP RA001

  up to

  $3,466

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $1,023

• Delivery - Cesarean

  SSP OB002

  up to

  $19,350

• Delivery - Vaginal

  SSP OB001

  up to

  $13,245

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $10,966

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $7,272

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $8,375

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $15,628

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $15,711

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $14,045

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $8,295

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $16,475

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $18,059

• MRI with Contrast

  SSP RA007

  up to

  $709

• MRI without Contrast

  SSP RA005

  up to

  $1,250

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $11,098

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $13,214

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $9,573

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $17,629

• Ultrasound

  SSP RA008

  up to

  $964

• X-Ray

  SSP RA000

  up to

  $267