Holtz Childrens Hospital

Provider Information

Services

• Breast MRI

  SSP RA011

  up to

  $245

• Breast Ultrasound

  SSP RA012

  up to

  $116

• Bronchoscopy

  SSP PU000

  up to

  $1,591

• CT

  SSP RA001

  up to

  $190

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $401

• Fetal MRI

  SSP RA006

  up to

  $245

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $662

• MRI with Contrast

  SSP RA007

  up to

  $392

• MRI without Contrast

  SSP RA005

  up to

  $245

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $1,496

• Ultrasound

  SSP RA008

  up to

  $116

• X-Ray

  SSP RA000

  up to

  $116