UCI Medical Center

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $24,309

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $16,982

• Breast MRI

  SSP RA011

  up to

  $3,594

• Breast Ultrasound

  SSP RA012

  up to

  $1,117

• Bronchoscopy

  SSP PU000

  up to

  $6,269

• Carpal Tunnel Repair

  SSP NU002

  up to

  $17,026

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $13,002

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $16,953

• Colonoscopy

  SSP GA002

  up to

  $4,019

• Colonoscopy via Stoma

  SSP GA000

  up to

  $3,780

• CT

  SSP RA001

  up to

  $3,607

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $4,042

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $2,657

• Fetal MRI

  SSP RA006

  up to

  $2,295

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $3,467

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $3,130

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $34,992

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $22,486

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $41,281

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $26,275

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $24,754

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $35,098

• Mammogram

  SSP RA010

  up to

  $670

• MRI with Contrast

  SSP RA007

  up to

  $3,607

• MRI without Contrast

  SSP RA005

  up to

  $2,391

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $6,482

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $40,881

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $33,976

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $4,865

• Ultrasound

  SSP RA008

  up to

  $1,122

• X-Ray

  SSP RA000

  up to

  $1,076