Jefferson Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $302

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $4,926

• Breast MRI

  SSP RA011

  up to

  $2,302

• Breast Ultrasound

  SSP RA012

  up to

  $540

• Bronchoscopy

  SSP PU000

  up to

  $5,308

• Carpal Tunnel Repair

  SSP NU002

  up to

  $278

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $389

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $4,610

• Colonoscopy

  SSP GA002

  up to

  $136

• Colonoscopy via Stoma

  SSP GA000

  up to

  $119

• CT

  SSP RA001

  up to

  $862

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $1,082

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $93

• Fetal MRI

  SSP RA006

  up to

  $76

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $2,038

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $923

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $304

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $340

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $545

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $190

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $371

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $381

• Mammogram

  SSP RA010

  up to

  $470

• MRI with Contrast

  SSP RA007

  up to

  $4,122

• MRI without Contrast

  SSP RA005

  up to

  $2,232

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $4,498

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $572

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $157

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $163

• Ultrasound

  SSP RA008

  up to

  $614

• X-Ray

  SSP RA000

  up to

  $826