White Plains Hospital

Provider Information

Services

• Ankle Repair - Arthroscopic

  SSP MS009

  up to

  $1,329

• Articular Finger Fracture Repair - Surgical

  SSP MS019

  up to

  $1,570

• Breast MRI

  SSP RA011

  up to

  $5,319

• Breast Ultrasound

  SSP RA012

  up to

  $853

• Bronchoscopy

  SSP PU000

  up to

  $1,724

• Carpal Tunnel Repair

  SSP NU002

  up to

  $1,372

• Cataract Removal with Intraocular Lens Insertion

  SSP OP000

  up to

  $1,989

• Clavicle/Scapula Repair - Non-Surgical

  SSP MS028

  up to

  $1,653

• Colonoscopy

  SSP GA002

  up to

  $5,802

• Colonoscopy via Stoma

  SSP GA000

  up to

  $1,505

• CT

  SSP RA001

  up to

  $2,061

• CT of Abdomen and Pelvis

  SSP RA004

  up to

  $3,991

• Esophagogastroduodenoscopy, Simple

  SSP GA007

  up to

  $4,233

• Fetal MRI

  SSP RA006

  up to

  $93

• Fine Needle Aspiration Biopsy with Ultrasound Guidance

  SSP DE003

  up to

  $1,696

• Forearm/Wrist Repair - Non-Surgical

  SSP MS010

  up to

  $780

• Hernia Repair - Laparoscopic

  SSP GA010

  up to

  $1,175

• Hernia Repair - Non-Laparoscopic

  SSP GA011

  up to

  $1,609

• Hip Repair - Arthroscopic

  SSP MS008

  up to

  $2,672

• Hysteroscopy with Surgical Procedure

  SSP RE003

  up to

  $810

• Knee Repair - Arthroscopic

  SSP MS006

  up to

  $1,670

• Laparoscopic Surgery of Ovaries and/or Fallopian Tubes

  SSP RE004

  up to

  $1,683

• Mammogram

  SSP RA010

  up to

  $1,011

• MRI with Contrast

  SSP RA007

  up to

  $5,194

• MRI without Contrast

  SSP RA005

  up to

  $3,489

• Percutaneous Breast Biopsy

  SSP DE000

  up to

  $3,480

• Shoulder Repair, Complex - Arthroscopic

  SSP MS005

  up to

  $2,796

• Tonsil and Adenoid Removal (Child Under 12)

  SSP EN000

  up to

  $754

• Tonsil and/or Adenoid Removal

  SSP EN004

  up to

  $754

• Ultrasound

  SSP RA008

  up to

  $1,161

• X-Ray

  SSP RA000

  up to

  $663