Texas Childrens Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $9,634

• Breast MRI

  SSP RA011

  up to

  $2,233

• Breast Ultrasound

  SSP RA012

  up to

  $693

• Bronchoscopy

  SSP PU000

  up to

  $7,054

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $10,418

• Colonoscopy

  SSP GA002

  up to

  $9,882

• CT

  SSP RA001

  up to

  $3,192

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $5,004

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $8,615

• Fetal MRI

  SSP RA006

  up to

  $2,421

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,200

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $1,220

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $8,994

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $10,825

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $12,975

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $7,195

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $13,428

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $13,486

• MRI with Contrast

  SSP RA007

  up to

  $4,915

• MRI without Contrast

  SSP RA005

  up to

  $3,638

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $2,847

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $12,456

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $8,104

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $7,968

• Ultrasound

  SSP RA008

  up to

  $1,440

• X-Ray

  SSP RA000

  up to

  $699