Montefiore Hospital - Moses Campus

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $6,363

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $1,834

• Breast MRI

  SSP RA011

  up to

  $2,732

• Breast Ultrasound

  SSP RA012

  up to

  $1,181

• Bronchoscopy

  SSP PU000

  up to

  $1,491

• Carpal Tunnel Repair

  SSP NU002

  up to

  $4,843

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $7,308

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $2,279

• Colonoscopy

  SSP GA002

  up to

  $2,557

• Colonoscopy via Stoma

  SSP GA000

  up to

  $2,930

• CT

  SSP RA001

  up to

  $3,773

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $3,449

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $1,929

• Fetal MRI

  SSP RA006

  up to

  $2,616

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $517

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $5,602

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $4,235

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $5,219

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $7,655

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $11,815

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $6,975

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $13,168

• Mammogram

  SSP RA010

  up to

  $736

• MRI with Contrast

  SSP RA007

  up to

  $5,595

• MRI without Contrast

  SSP RA005

  up to

  $3,738

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $4,339

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $11,595

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $2,744

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $2,848

• Ultrasound

  SSP RA008

  up to

  $1,285

• X-Ray

  SSP RA000

  up to

  $876