University of Utah Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $15,015

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $2,753

• Breast MRI

  SSP RA011

  up to

  $1,622

• Breast Ultrasound

  SSP RA012

  up to

  $304

• Bronchoscopy

  SSP PU000

  up to

  $3,418

• Carpal Tunnel Repair

  SSP NU002

  up to

  $5,247

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $4,786

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $3,209

• Colonoscopy

  SSP GA002

  up to

  $3,586

• Colonoscopy via Stoma

  SSP GA000

  up to

  $2,408

• CT

  SSP RA001

  up to

  $2,409

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $1,048

• Delivery - Cesarean

  SSP OB002

  up to

  $27,001

• Delivery - Vaginal

  SSP OB001

  up to

  $17,541

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $2,355

• Fetal MRI

  SSP RA006

  up to

  $1,648

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,074

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $853

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $10,797

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $7,176

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $27,512

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $7,901

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $15,532

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $16,517

• Mammogram

  SSP RA010

  up to

  $317

• MRI with Contrast

  SSP RA007

  up to

  $1,641

• MRI without Contrast

  SSP RA005

  up to

  $1,742

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $4,290

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $18,822

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $7,710

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $8,009

• Ultrasound

  SSP RA008

  up to

  $292

• X-Ray

  SSP RA000

  up to

  $250