Mayo Eugenio Litta Childrens Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $35,587

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $3,025

• Breast MRI

  SSP RA011

  up to

  $3,123

• Breast Ultrasound

  SSP RA012

  up to

  $1,005

• Bronchoscopy

  SSP PU000

  up to

  $8,385

• Carpal Tunnel Repair

  SSP NU002

  up to

  $8,918

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $10,641

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $2,935

• Colonoscopy

  SSP GA002

  up to

  $7,951

• Colonoscopy via Stoma

  SSP GA000

  up to

  $7,148

• CT

  SSP RA001

  up to

  $3,692

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $4,115

• Delivery - Cesarean

  SSP OB002

  up to

  $35,701

• Delivery - Vaginal

  SSP OB001

  up to

  $35,070

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $6,894

• Fetal MRI

  SSP RA006

  up to

  $3,341

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $2,296

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $2,029

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $26,014

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $20,613

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $41,230

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $15,208

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $17,260

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $31,584

• Mammogram

  SSP RA010

  up to

  $1,006

• MRI with Contrast

  SSP RA007

  up to

  $5,763

• MRI without Contrast

  SSP RA005

  up to

  $4,173

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $4,538

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $35,668

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $11,042

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $12,500

• Ultrasound

  SSP RA008

  up to

  $1,305

• X-Ray

  SSP RA000

  up to

  $1,270