Upper Connecticut Valley Hospital

Provider Information

Services

• Breast MRI

  SSP RA011

  up to

  $3,006

• Breast Ultrasound

  SSP RA012

  up to

  $870

• Bronchoscopy

  SSP PU000

  up to

  $8,223

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $4,329

• Colonoscopy

  SSP GA002

  up to

  $4,740

• Colonoscopy via Stoma

  SSP GA000

  up to

  $2,960

• CT

  SSP RA001

  up to

  $3,084

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $4,280

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $4,702

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,069

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $1,338

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $9,002

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $6,993

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $7,058

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $11,439

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $9,366

• Mammogram

  SSP RA010

  up to

  $977

• MRI with Contrast

  SSP RA007

  up to

  $5,027

• MRI without Contrast

  SSP RA005

  up to

  $3,745

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $3,162

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $13,064

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $5,025

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $5,007

• Ultrasound

  SSP RA008

  up to

  $886

• X-Ray

  SSP RA000

  up to

  $548