M Health Fairview Southdale Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $7,839

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $4,041

• Breast MRI

  SSP RA011

  up to

  $3,269

• Breast Ultrasound

  SSP RA012

  up to

  $476

• Bronchoscopy

  SSP PU000

  up to

  $5,976

• Carpal Tunnel Repair

  SSP NU002

  up to

  $4,093

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $5,730

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $3,973

• Colonoscopy

  SSP GA002

  up to

  $4,523

• Colonoscopy via Stoma

  SSP GA000

  up to

  $4,135

• CT

  SSP RA001

  up to

  $1,546

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $1,544

• Delivery - Cesarean

  SSP OB002

  up to

  $32,234

• Delivery - Vaginal

  SSP OB001

  up to

  $21,870

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $2,971

• Fetal MRI

  SSP RA006

  up to

  $1,525

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,640

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $983

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $13,608

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $8,481

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $18,778

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $11,772

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $8,493

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $13,874

• Mammogram

  SSP RA010

  up to

  $1,508

• MRI with Contrast

  SSP RA007

  up to

  $1,530

• MRI without Contrast

  SSP RA005

  up to

  $1,637

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $3,880

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $18,204

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $13,543

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $7,709

• Ultrasound

  SSP RA008

  up to

  $430

• X-Ray

  SSP RA000

  up to

  $382