Holy Cross Hospital - Davis

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $12,200

• Breast MRI

  SSP RA011

  up to

  $2,701

• Breast Ultrasound

  SSP RA012

  up to

  $250

• Bronchoscopy

  SSP PU000

  up to

  $6,202

• Carpal Tunnel Repair

  SSP NU002

  up to

  $4,393

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $3,527

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $5,284

• Colonoscopy

  SSP GA002

  up to

  $6,467

• Colonoscopy via Stoma

  SSP GA000

  up to

  $5,136

• CT

  SSP RA001

  up to

  $3,739

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $5,974

• Delivery - Cesarean

  SSP OB002

  up to

  $29,660

• Delivery - Vaginal

  SSP OB001

  up to

  $11,926

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $4,971

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,983

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $5,247

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $8,797

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $7,530

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $22,786

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $7,908

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $12,674

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $15,086

• Mammogram

  SSP RA010

  up to

  $252

• MRI with Contrast

  SSP RA007

  up to

  $2,202

• MRI without Contrast

  SSP RA005

  up to

  $1,053

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $5,153

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $15,442

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $5,266

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $4,689

• Ultrasound

  SSP RA008

  up to

  $253

• X-Ray

  SSP RA000

  up to

  $201