Mountain Lakes Medical Center

Provider Information

Services

• Breast Ultrasound

  SSP RA012

  up to

  $104

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $2,669

• Colonoscopy

  SSP GA002

  up to

  $1,339

• CT

  SSP RA001

  up to

  $1,433

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $440

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $1,020

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $134

• MRI with Contrast

  SSP RA007

  up to

  $589

• MRI without Contrast

  SSP RA005

  up to

  $374

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $6,600

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $3,517

• Ultrasound

  SSP RA008

  up to

  $221

• X-Ray

  SSP RA000

  up to

  $152