Pennsylvania Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $6,010

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $3,048

• Breast MRI

  SSP RA011

  up to

  $1,368

• Breast Ultrasound

  SSP RA012

  up to

  $282

• Bronchoscopy

  SSP PU000

  up to

  $3,171

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $7,056

• Colonoscopy

  SSP GA002

  up to

  $3,814

• Colonoscopy via Stoma

  SSP GA000

  up to

  $3,372

• CT

  SSP RA001

  up to

  $2,747

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $1,040

• Delivery - Cesarean

  SSP OB002

  up to

  $20,557

• Delivery - Vaginal

  SSP OB001

  up to

  $20,826

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $2,777

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,256

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $5,673

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $14,795

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $6,085

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $22,900

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $11,910

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $9,694

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $25,428

• Mammogram

  SSP RA010

  up to

  $261

• MRI with Contrast

  SSP RA007

  up to

  $1,174

• MRI without Contrast

  SSP RA005

  up to

  $1,074

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $2,645

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $17,934

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $9,228

• Ultrasound

  SSP RA008

  up to

  $1,924

• X-Ray

  SSP RA000

  up to

  $695