Bellevue Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $5,854

• Breast MRI

  SSP RA011

  up to

  $862

• Breast Ultrasound

  SSP RA012

  up to

  $413

• Bronchoscopy

  SSP PU000

  up to

  $5,028

• Carpal Tunnel Repair

  SSP NU002

  up to

  $2,362

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $3,225

• Colonoscopy

  SSP GA002

  up to

  $2,795

• Colonoscopy via Stoma

  SSP GA000

  up to

  $2,343

• CT

  SSP RA001

  up to

  $1,337

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $1,910

• Delivery - Cesarean

  SSP OB002

  up to

  $12,318

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $1,938

• Fetal MRI

  SSP RA006

  up to

  $922

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $804

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $797

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $14,282

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $14,620

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $17,220

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $4,193

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $5,831

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $16,866

• Mammogram

  SSP RA010

  up to

  $391

• MRI with Contrast

  SSP RA007

  up to

  $2,105

• MRI without Contrast

  SSP RA005

  up to

  $1,033

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $2,600

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $10,565

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $3,411

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $3,650

• Ultrasound

  SSP RA008

  up to

  $364

• X-Ray

  SSP RA000

  up to

  $322