Dayton Childrens Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $15,247

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $1,178

• Breast MRI

  SSP RA011

  up to

  $1,747

• Breast Ultrasound

  SSP RA012

  up to

  $1,821

• Bronchoscopy

  SSP PU000

  up to

  $13,250

• Carpal Tunnel Repair

  SSP NU002

  up to

  $3,706

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $4,458

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $1,563

• Colonoscopy

  SSP GA002

  up to

  $6,695

• Colonoscopy via Stoma

  SSP GA000

  up to

  $3,820

• CT

  SSP RA001

  up to

  $4,803

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $8,162

• Delivery - Cesarean

  SSP OB002

  up to

  $14,297

• Delivery - Vaginal

  SSP OB001

  up to

  $13,948

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $4,730

• Fetal MRI

  SSP RA006

  up to

  $1,126

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $2,274

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $1,642

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $11,989

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $11,744

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $16,073

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $7,448

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $14,264

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $15,727

• Mammogram

  SSP RA010

  up to

  $484

• MRI with Contrast

  SSP RA007

  up to

  $7,972

• MRI without Contrast

  SSP RA005

  up to

  $4,669

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $8,095

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $15,625

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $4,478

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $5,247

• Ultrasound

  SSP RA008

  up to

  $1,812

• X-Ray

  SSP RA000

  up to

  $924