Childrens Hospital at Montefiore

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $2,954

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $1,869

• Breast MRI

  SSP RA011

  up to

  $2,259

• Breast Ultrasound

  SSP RA012

  up to

  $684

• Bronchoscopy

  SSP PU000

  up to

  $5,835

• Carpal Tunnel Repair

  SSP NU002

  up to

  $2,739

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $3,634

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $2,067

• Colonoscopy

  SSP GA002

  up to

  $5,515

• Colonoscopy via Stoma

  SSP GA000

  up to

  $5,229

• CT

  SSP RA001

  up to

  $1,728

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $2,133

• Delivery - Vaginal

  SSP OB001

  up to

  $53,445

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $5,098

• Fetal MRI

  SSP RA006

  up to

  $2,148

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $658

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $2,037

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $3,561

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $7,055

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $8,022

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $4,066

• Mammogram

  SSP RA010

  up to

  $1,034

• MRI with Contrast

  SSP RA007

  up to

  $2,119

• MRI without Contrast

  SSP RA005

  up to

  $2,170

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $2,458

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $6,715

• Ultrasound

  SSP RA008

  up to

  $1,194

• X-Ray

  SSP RA000

  up to

  $667