Holy Cross Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $8,423

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $1,558

• Breast MRI

  SSP RA011

  up to

  $1,230

• Breast Ultrasound

  SSP RA012

  up to

  $911

• Bronchoscopy

  SSP PU000

  up to

  $11,978

• Carpal Tunnel Repair

  SSP NU002

  up to

  $4,252

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $6,533

• Colonoscopy

  SSP GA002

  up to

  $3,844

• Colonoscopy via Stoma

  SSP GA000

  up to

  $2,844

• CT

  SSP RA001

  up to

  $672

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $2,646

• Delivery - Cesarean

  SSP OB002

  up to

  $14,783

• Delivery - Vaginal

  SSP OB001

  up to

  $17,439

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $3,920

• Fetal MRI

  SSP RA006

  up to

  $961

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $707

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $604

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $7,934

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $6,884

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $18,410

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $7,952

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $12,990

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $12,718

• Mammogram

  SSP RA010

  up to

  $808

• MRI with Contrast

  SSP RA007

  up to

  $2,023

• MRI without Contrast

  SSP RA005

  up to

  $1,759

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $3,648

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $12,419

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $6,079

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $5,967

• Ultrasound

  SSP RA008

  up to

  $742

• X-Ray

  SSP RA000

  up to

  $386