UVA Childrens Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $25,366

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $5,336

• Breast MRI

  SSP RA011

  up to

  $1,235

• Breast Ultrasound

  SSP RA012

  up to

  $937

• Bronchoscopy

  SSP PU000

  up to

  $25,105

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $14,472

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $5,212

• Colonoscopy

  SSP GA002

  up to

  $9,395

• Colonoscopy via Stoma

  SSP GA000

  up to

  $6,781

• CT

  SSP RA001

  up to

  $2,682

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $3,753

• Delivery - Cesarean

  SSP OB002

  up to

  $33,590

• Delivery - Vaginal

  SSP OB001

  up to

  $24,903

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $6,191

• Fetal MRI

  SSP RA006

  up to

  $1,648

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $4,938

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $2,475

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $34,754

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $25,447

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $37,197

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $29,882

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $39,246

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $34,881

• Mammogram

  SSP RA010

  up to

  $924

• MRI with Contrast

  SSP RA007

  up to

  $2,765

• MRI without Contrast

  SSP RA005

  up to

  $984

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $6,724

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $36,548

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $18,057

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $14,053

• Ultrasound

  SSP RA008

  up to

  $1,813

• X-Ray

  SSP RA000

  up to

  $834