St Josephs Hospital

Provider Information

Services

• Breast MRI

  SSP RA011

  up to

  $2,280

• Breast Ultrasound

  SSP RA012

  up to

  $281

• Bronchoscopy

  SSP PU000

  up to

  $221

• CT

  SSP RA001

  up to

  $976

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $1,653

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $144

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $1,327

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $636

• Mammogram

  SSP RA010

  up to

  $151

• MRI with Contrast

  SSP RA007

  up to

  $1,527

• MRI without Contrast

  SSP RA005

  up to

  $1,012

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $1,458

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $259

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $269

• Ultrasound

  SSP RA008

  up to

  $491

• X-Ray

  SSP RA000

  up to

  $383