Jefferson Einstein Montgomery Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $3,804

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $1,876

• Breast MRI

  SSP RA011

  up to

  $283

• Breast Ultrasound

  SSP RA012

  up to

  $125

• Bronchoscopy

  SSP PU000

  up to

  $21,562

• Carpal Tunnel Repair

  SSP NU002

  up to

  $1,876

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $2,674

• Colonoscopy

  SSP GA002

  up to

  $1,382

• Colonoscopy via Stoma

  SSP GA000

  up to

  $1,136

• CT

  SSP RA001

  up to

  $419

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $471

• Delivery - Cesarean

  SSP OB002

  up to

  $22,424

• Delivery - Vaginal

  SSP OB001

  up to

  $14,836

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $1,069

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $812

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $281

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $6,841

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $6,980

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $8,376

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $5,788

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $3,804

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $6,841

• Mammogram

  SSP RA010

  up to

  $134

• MRI with Contrast

  SSP RA007

  up to

  $419

• MRI without Contrast

  SSP RA005

  up to

  $283

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $1,900

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $8,376

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $6,936

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $3,802

• Ultrasound

  SSP RA008

  up to

  $125

• X-Ray

  SSP RA000

  up to

  $125