C S Mott Childrens Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $1,249

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $1,947

• Breast MRI

  SSP RA011

  up to

  $1,058

• Breast Ultrasound

  SSP RA012

  up to

  $58

• Bronchoscopy

  SSP PU000

  up to

  $2,402

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $1,488

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $1,650

• Colonoscopy

  SSP GA002

  up to

  $2,424

• Colonoscopy via Stoma

  SSP GA000

  up to

  $1,612

• CT

  SSP RA001

  up to

  $270

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $244

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $2,744

• Fetal MRI

  SSP RA006

  up to

  $554

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $416

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $556

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $830

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $865

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $1,948

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $969

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $1,869

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $1,315

• Mammogram

  SSP RA010

  up to

  $74

• MRI with Contrast

  SSP RA007

  up to

  $457

• MRI without Contrast

  SSP RA005

  up to

  $537

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $295

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $2,353

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $495

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $508

• Ultrasound

  SSP RA008

  up to

  $124

• X-Ray

  SSP RA000

  up to

  $104