Lucile Packard Childrens Hospital Stanford

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $31,540

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $8,209

• Breast Ultrasound

  SSP RA012

  up to

  $1,329

• Bronchoscopy

  SSP PU000

  up to

  $15,207

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $24,348

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $11,551

• Colonoscopy

  SSP GA002

  up to

  $14,706

• Colonoscopy via Stoma

  SSP GA000

  up to

  $14,449

• CT

  SSP RA001

  up to

  $7,717

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $9,621

• Delivery - Cesarean

  SSP OB002

  up to

  $44,311

• Delivery - Vaginal

  SSP OB001

  up to

  $25,842

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $14,088

• Fetal MRI

  SSP RA006

  up to

  $6,911

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $11,392

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $8,197

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $46,929

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $31,592

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $48,438

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $38,902

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $31,984

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $47,035

• MRI with Contrast

  SSP RA007

  up to

  $8,564

• MRI without Contrast

  SSP RA005

  up to

  $7,620

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $14,239

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $48,038

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $24,037

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $24,078

• Ultrasound

  SSP RA008

  up to

  $2,928

• X-Ray

  SSP RA000

  up to

  $1,935