Mayo Eugenio Litta Childrens Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $3,938

• Breast MRI

  SSP RA011

  up to

  $3,524

• Breast Ultrasound

  SSP RA012

  up to

  $330

• Bronchoscopy

  SSP PU000

  up to

  $5,708

• Carpal Tunnel Repair

  SSP NU002

  up to

  $3,080

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $4,424

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $1,757

• Colonoscopy

  SSP GA002

  up to

  $4,545

• Colonoscopy via Stoma

  SSP GA000

  up to

  $4,472

• CT

  SSP RA001

  up to

  $1,972

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $2,321

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $5,763

• Fetal MRI

  SSP RA006

  up to

  $2,275

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,897

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $1,192

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $2,997

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $3,954

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $6,033

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $6,984

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $4,460

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $3,811

• Mammogram

  SSP RA010

  up to

  $514

• MRI with Contrast

  SSP RA007

  up to

  $4,046

• MRI without Contrast

  SSP RA005

  up to

  $3,224

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $3,568

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $6,590

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $1,750

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $1,497

• Ultrasound

  SSP RA008

  up to

  $781

• X-Ray

  SSP RA000

  up to

  $424