Penn Highlands DuBois

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $7,734

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $2,339

• Breast MRI

  SSP RA011

  up to

  $2,972

• Breast Ultrasound

  SSP RA012

  up to

  $765

• Carpal Tunnel Repair

  SSP NU002

  up to

  $2,334

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $2,354

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $2,258

• Colonoscopy

  SSP GA002

  up to

  $5,438

• Colonoscopy via Stoma

  SSP GA000

  up to

  $5,059

• CT

  SSP RA001

  up to

  $2,968

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $2,965

• Delivery - Cesarean

  SSP OB002

  up to

  $21,556

• Delivery - Vaginal

  SSP OB001

  up to

  $14,004

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $3,270

• Fetal MRI

  SSP RA006

  up to

  $1,830

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $3,195

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $3,822

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $9,647

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $5,569

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $12,240

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $8,185

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $9,759

• Mammogram

  SSP RA010

  up to

  $386

• MRI with Contrast

  SSP RA007

  up to

  $2,957

• MRI without Contrast

  SSP RA005

  up to

  $1,913

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $5,571

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $11,831

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $7,255

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $3,250

• Ultrasound

  SSP RA008

  up to

  $727

• X-Ray

  SSP RA000

  up to

  $688