Lyndon B Johnson Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $5,811

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $2,943

• Breast MRI

  SSP RA011

  up to

  $3,896

• Breast Ultrasound

  SSP RA012

  up to

  $749

• Bronchoscopy

  SSP PU000

  up to

  $4,766

• Carpal Tunnel Repair

  SSP NU002

  up to

  $4,968

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $5,997

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $2,776

• Colonoscopy

  SSP GA002

  up to

  $2,320

• Colonoscopy via Stoma

  SSP GA000

  up to

  $3,461

• CT

  SSP RA001

  up to

  $2,939

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $4,481

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $1,089

• Fetal MRI

  SSP RA006

  up to

  $744

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $709

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $1,419

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $13,669

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $7,596

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $40,709

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $8,018

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $8,932

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $10,389

• Mammogram

  SSP RA010

  up to

  $550

• MRI with Contrast

  SSP RA007

  up to

  $4,268

• MRI without Contrast

  SSP RA005

  up to

  $3,342

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $4,295

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $15,327

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $10,799

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $6,605

• Ultrasound

  SSP RA008

  up to

  $933

• X-Ray

  SSP RA000

  up to

  $660