Seattle Children's Hospital

SeattleKing CountyChildrens

Forearm X-ray

Quality: not rated by CMSEarliest available date: call (206) 987-2000

What you may pay

With insurance from an employer or private plan: $12.80 – $1,139At least one plan lists 3 separate amounts for this procedure. They may be parts of one bill that you pay together (for example the hospital’s fee and the fee of the doctor who reads a scan) or alternatives (inpatient or outpatient). We don’t show one price or compare it until we can tell which; every line is listed below. Ask the hospital which lines apply to you.
Paying yourself (cash price): $32.00 – $1,186The hospital lists 3 separate amounts for this procedure. They may be parts of one bill that you pay together (for example the hospital’s fee and the fee of the doctor who reads a scan) or alternatives (inpatient or outpatient). We don’t show one price or compare it until we can tell which; every line is listed below. Ask the hospital which lines apply to you.

These are prices the hospital published, not a quote. With insurance you usually pay part of the rate (your deductible and coinsurance); the estimator on the procedure page works it out. A higher price does not mean better care.

Doctors usually bill separately. At most hospitals these are the hospital’s own charges. The surgeon, radiologist, anesthesiologist or pathologist usually sends a separate bill: ask each of them for an estimate too.

Source: Seattle Children's Hospital’s own price file. CareNavIQ last refreshed prices on 2026-11-05.

Next step: ask the hospital for a Good Faith Estimate for this procedure (phone number above).

Bills to expect

A procedure usually brings several bills, each from whoever did that part of your care. Here is what to expect, with what Traditional Medicare allows for each doctor’s part in this area (King County) and an estimate for private plans.

Separate bills for this procedure and their estimated amounts
Bill	Who sends it	How likely	Status	Traditional Medicare allows	Private plans (estimate)
Hospital's feeThe X-ray: equipment and technologist	The hospital	Expected	Published by the hospital: the prices above	—	—
RadiologistReading the X-ray and writing the report	The radiology group	Expected	Billed separately; amount estimated	$8	$10 to $15
Ordering doctor's visitThe visit where the X-ray is ordered or the results are explained	Your doctor	Possible	Billed separately; not priced	—	—

What you’d pay for these bills

Adds up your share of the hospital’s bill and the expected doctors’ bills above (not the possible ones). What you type stays in your browser.

Your coverage Insurance from an employer or a private plan Traditional Medicare Medicare Advantage Apple Health (Medicaid)

Your plan’s price at this hospitalDeductible you still have to pay this yearYour coinsurance after the deductibleOut-of-pocket maximum you have left this year (optional)

Your plan’s summary of benefits says how it charges for each kind of care. Leave these as they are if it uses the deductible and coinsurance.

The hospital's billHow your plan charges

The bill from the doctor doing the procedureHow your plan charges

You pay about $5 to $6 of about $27 to $32 billed to your plan.

Your share of the hospital's bill is about $3; the rest is your share of the doctors' bills. The doctors' bills are estimates. Enter your out-of-pocket maximum to see whether you'd reach it. Assumes everyone is in your network.

How each bill comes to you

Each provider sends a claim to your plan. It applies its allowed amount, then your deductible, copay and coinsurance, and sends you an Explanation of Benefits. Then the provider bills you the “You owe” line. Bills are in the order your plan is assumed to process them, the hospital first. The doctors' bills are estimates.

Show the bills at the lower estimate the higher estimate

Hospital's feeSent by the hospital
The provider's chargeThe hospital's price file doesn't list one charge for this; in network it doesn't change what you owe.
Not published
Allowed amountWhat the insurer counts for this bill.
$16.68
Your plan pays
$13.34
Your coinsurance
$3.34
You oweThe provider bills you this after the insurer pays.
$3.34
RadiologistSent by the radiology group
The provider's chargeDoctors don't publish their charges; in network it doesn't change what you owe.
Not published
Allowed amountWhat the insurer counts for this bill.
$9.84
Your plan pays
$7.87
Your coinsurance
$1.97
You oweThe provider bills you this after the insurer pays.
$1.97

All bills: allowed amounts: $26.52
Your plan pays: $21.21
You owe in all: $5.31

Who owes what, and when you might owe more

The insurance adjustment Written off
An in-network provider agrees to accept your plan's allowed amount. The difference between its charge and that amount is written off: you don't owe it, and it shouldn't appear on your bill.
Deductible You pay
What you pay each year before your plan starts sharing costs. It is applied to bills in the order your plan processes them, so the first bill can take all of it.
Copay You pay
A fixed amount for a kind of care, such as a hospital stay or a surgeon's visit. Your plan's summary of benefits says whether it applies before or after the deductible, and whether a stay's copay is per day.
Coinsurance You pay
Your percentage of the allowed amount after the deductible, such as 20%.
Out-of-pocket maximum Your plan pays
Once your deductible, copays and coinsurance for the year reach it, your plan pays 100% of covered in-network care for the rest of the plan year.
Each provider bills separately You pay
The hospital, surgeon, anesthesia group, radiologist and pathologist each send their own claim and their own bill. All of them count toward the same deductible and yearly maximum.
Out of network and surprise bills It depends
A provider outside your plan's network can bill you the difference between its charge and what your plan pays (a balance bill). It can't for emergency care, or when anesthesia, radiology, pathology, an assistant surgeon or a hospital doctor treats you at an in-network hospital: under federal law (the No Surprises Act) and, for Washington-regulated plans and self-funded plans that opt in, RCW 48.49, those groups cannot balance bill you. Your deductible and coinsurance still apply, at in-network amounts.
Not covered, or no prior authorization It depends
If your plan decides a service isn't covered, or it needed prior authorization that wasn't approved, the plan pays nothing for it and the provider may bill you. Ask the provider to get prior authorization before your care. If an in-network provider didn't get it, the provider's contract may stop it billing you: ask your plan before you pay.
A second insurance It depends
If you have a second plan, the first plan pays first and the second may then pay some or all of your share. These estimates use one plan only.
Wait for the Explanation of Benefits You pay
After each claim your insurer sends an Explanation of Benefits (EOB) with the allowed amount, what it paid and what you may owe. It is not a bill. Pay a provider's bill only when it matches the EOB's “you may owe” amount, and ask the provider or insurer about any difference.
Help from the hospital It depends
Washington hospitals must give free or discounted care based on income, including deductibles and coinsurance for insured patients: free up to 200% or 300% of the federal poverty level depending on the hospital, with discounts above that (RCW 70.170). You can apply after you get a bill. It covers the hospital's bill; doctor groups that bill separately have their own policies.
If you pay yourself instead You pay
You can choose not to use your insurance and pay the cash price; then nothing counts toward your deductible. Ask each provider for a Good Faith Estimate. If a bill is $400 or more above it, you can dispute it within 120 days.

Get it confirmed before your care

The hospital, each doctor’s group and your insurer can each confirm their part in writing. Here is a request for each one, ready to send from your own email, and what to say if you’d rather call. Nothing you do here is saved.

Coming: CareNavIQ will be able to send these for you, follow up, and tell you when everything is confirmed, with your permission.

How you’ll payWith insurancePaying myself, without insurance

Seattle Children's Hospital

The largest bill.

Request to send

Subject: Estimate request: forearm x-ray at Seattle Children's Hospital

Hello,

I am planning a forearm x-ray (billing code CPT 73090) at Seattle Children's Hospital.

Under Washington law (RCW 70.01.030), I am asking for a written estimate of the hospital's charges, with the billing codes you plan to use.

Name: [YOUR NAME]
Date of birth: [DATE OF BIRTH]
Insurance: [PLAN NAME], member ID [MEMBER ID]
Planned date: [DATE, IF KNOWN]

Thank you.

Replace the words in [brackets] with your details before you send it.

Open in my email

If you call. Call (206) 987-2000 and ask for the price estimate or patient financial services line. Say: "I'd like a written estimate for my forearm x-ray."

I’ve sent this one

0 of 3 sent. Washington law gives you the right to these estimates but sets no deadline: if you haven't heard back in five business days, send it again or call.

How these are worked out. Medicare amounts are CMS’s 2026 physician fee schedule for this area, at the rate for care in a hospital. Private-plan estimates are 118% to 179% of Medicare for doctors (the range across 19 studies in KFF’s review of what private insurers pay) and 3 to 5 times Medicare for anesthesia (a published industry estimate). Anesthesia is paid by the minute, so its range assumes the time shown. Medicare pays an assistant at surgery 13.6% to 16% of the surgeon’s fee. Where we have your insurer’s own published rates for the doctors here (below), the estimator uses those for that insurer’s employer plans instead. Your plan’s own rates may be outside these ranges: ask each office for an estimate, and for its network status. At an in-network hospital, the anesthesia, radiology, pathology and assistant groups can’t charge you more than your in-network cost share, even if they are out of network (No Surprises Act).

994 published prices, grouped by who each price applies to.

Cash price 5 prices

The hospital's discounted price for patients paying without insurance.

Cash price prices for Forearm X-ray at Seattle Children's Hospital
Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
$32.00	Hospital’s fee	X-Ray Forearm	—	Inpatient or outpatient	—
$564	Hospital’s fee	Xray Forearm 2v	—	Outpatient	—
$1,186	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	—	Outpatient	—
$1,186	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	—	Outpatient	—
$1,186	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	—	Outpatient	—

List price (before discounts) 11 prices

The hospital's full chargemaster price. Few patients pay this amount.

List price (before discounts) prices for Forearm X-ray at Seattle Children's Hospital
Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	—	Outpatient	—
$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	—	Inpatient	—
$32.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	—	Inpatient or outpatient	—
$32.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	—	Inpatient or outpatient	—
$32.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	—	Inpatient	—
$32.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	—	Outpatient	—
$32.00	Hospital’s fee	X-Ray Forearm	—	Inpatient or outpatient	—
$564	Hospital’s fee	Xray Forearm 2v	—	Outpatient	—
$1,186	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	—	Outpatient	—
$1,186	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	—	Outpatient	—
$1,186	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	—	Outpatient	—

Commercial insurance 732 prices

Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.

Commercial insurance prices for Forearm X-ray at Seattle Children's Hospital
Payer	Plan	Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
ADMINISTRATORS [13102]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
ADMINISTRATORS [13102]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
ADMINISTRATORS [13102]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$451	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$949	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$949	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$949	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$423	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
AETNA [11000]	Aetna PPO	$473	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
AETNA [11000]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
AETNA [11000]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
AETNA [11000]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
ALLEGIANCE [12264]	Cigna	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
ALLEGIANCE [12264]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$18.90	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$16.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
ALLIED [13129]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
ALLIED [13129]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$541	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
AMERIBEN [11006]	Aetna	$17.46	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna PPO	$473	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
AMERIBEN [11006]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
AMERIBEN [11006]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
AMERIBEN [11006]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
ASURIS [11900]	Regence PPO	$468	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
ASURIS [11900]	Regence PPO	$985	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
ASURIS [11900]	Regence PPO	$985	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ASURIS [11900]	Regence PPO	$985	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASURIS [11913]	Regence Exchange	$304	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
ASURIS [11913]	Regence Exchange	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASURIS [11913]	Regence Exchange	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
ASURIS [11913]	Regence Exchange	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$468	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$985	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$985	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$985	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Blue Shield	$16.68	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$304	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$12.86	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$16.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$310	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$653	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$653	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$653	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna	$17.46	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$473	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna Narrow Network	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna Narrow Network	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna Narrow Network	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna Narrow Network	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
CLARITEV [12299]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
CLARITEV [12299]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan PPO	$535	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$13.34	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$19.20	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$19.20	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$24.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$423	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$13.34	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$19.20	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$19.20	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$24.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$310	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$653	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$653	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$653	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CORESOURCE [11004]	Aetna	$17.46	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna PPO	$473	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
CORESOURCE [11004]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
CORESOURCE [11004]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CORESOURCE [11004]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
COVENTRY FC [13112]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
COVENTRY FC [13112]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
COVENTRY FC [13112]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY FC [13112]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$541	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY [12244]	First Health PPO	$541	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
COVENTRY [12244]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
COVENTRY [12244]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
COVENTRY [12244]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
EBMS FC [13144]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
EBMS FC [13144]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS [11003]	Aetna	$17.46	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EBMS [11003]	Aetna PPO	$473	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
EBMS [11003]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS [11003]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
EBMS [11003]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
EBMS [12241]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
EBMS [12241]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan PPO	$535	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
FIRST CHOICE [13399]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
FIRST CHOICE [13399]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
FIRST HEALTH [12210]	First Health PPO	$541	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
FIRST HEALTH [12210]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
FIRST HEALTH [12210]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
FIRST HEALTH [12210]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
HCC MEDICAL [12274]	First Health PPO	$541	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
HCC MEDICAL [12274]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HCC MEDICAL [12274]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
HCC MEDICAL [12274]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$535	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
HEALTH ALLIANCE [13233]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
HEALTH ALLIANCE [13233]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
HUMANA [12224]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
HUMANA [12224]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan PPO	$535	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
ILWU-PMA [13158]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
ILWU-PMA [13158]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser Exchange	$310	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser Exchange	$653	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser Exchange	$653	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser Exchange	$653	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser HMO	$366	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser HMO	$771	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser HMO	$771	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser HMO	$771	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser PPO	$423	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser PPO	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser PPO	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser PPO	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser HMO	$366	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser HMO	$771	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser HMO	$771	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser HMO	$771	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$535	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
KPS [13109]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
KPS [13109]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
KPS [13109]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
KPS [13109]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
LEWERMARK [12286]	First Health PPO	$541	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
LEWERMARK [12286]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
LEWERMARK [12286]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
LEWERMARK [12286]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$535	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
MEDISHARE [12287]	First Health PPO	$541	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
MEDISHARE [12287]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MEDISHARE [12287]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
MEDISHARE [12287]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEGA LIFE [13111]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
MEGA LIFE [13111]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
MEGA LIFE [13111]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEGA LIFE [13111]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
MERITAIN HEALTH [13229]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
MERITAIN HEALTH [13229]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Aetna	$17.46	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MERITAIN [12251]	Aetna PPO	$473	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
MERITAIN [12251]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
MERITAIN [12251]	Multiplan	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan PPO	$535	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
MODA FC [13219]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
MODA FC [13219]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna PPO	$473	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
MODA [12842]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
MODA [12842]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan PPO	$535	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$423	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$13.95	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$19.20	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$19.20	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$24.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$535	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$541	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
PEHP [12235]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
PEHP [12235]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan PPO	$535	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$507	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$1,068	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$1,068	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$1,068	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
PERSONIFY FC [13155]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
PERSONIFY FC [13155]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
PERSONIFY [12270]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
PERSONIFY [12270]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$18.90	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$16.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREFERRED ONE [11008]	Aetna	$17.46	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$473	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$535	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera BC Heritage Prime	$17.27	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera BC Heritage Signature/Lifewise	$17.27	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera Exchange	$304	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Exchange	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Exchange	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Exchange	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera HMO	$383	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera HMO	$807	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera HMO	$807	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera HMO	$807	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Narrow Network	$411	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Narrow Network	$866	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Narrow Network	$866	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Narrow Network	$866	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera PPO	$468	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera PPO	$985	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera PPO	$985	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera PPO	$985	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Public Option	$304	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Public Option	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Public Option	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Public Option	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PSEW [13124]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
PSEW [13124]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PSEW [13124]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
PSEW [13124]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE UMP [12263]	Regence UMP	$15.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$366	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
REGENCE UMP [12263]	Regence UMP	$771	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE UMP [12263]	Regence UMP	$771	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
REGENCE UMP [12263]	Regence UMP	$771	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence Exchange	$304	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence Exchange	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence Exchange	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence Exchange	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence PPO	$468	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence PPO	$985	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence PPO	$985	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence PPO	$985	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
REGENCE [11909]	Regence Exchange	$304	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
REGENCE [11909]	Regence Exchange	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11909]	Regence Exchange	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
REGENCE [11909]	Regence Exchange	$641	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
REHN & ASSOCIATES [13182]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
REHN & ASSOCIATES [13182]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$541	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$1,139	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
SAMARITAN HEALTH [12265]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
SAMARITAN HEALTH [12265]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
SELECT HEALTH [12277]	Multiplan	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
SELECT HEALTH [12277]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
SELECT HEALTH [12277]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
SELECT HEALTH [12277]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$535	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$1,127	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
STARMARK [13103]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
STARMARK [13103]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
TRUSTEED PLANS [13186]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
TRUSTEED PLANS [13186]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
UMR [12246]	United Exchange	$19.20	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
UMR [12246]	United Exchange	$19.20	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
UMR [12246]	United Exchange	$20.15	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UMR [12246]	United Exchange	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
UMR [12246]	United Exchange	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
UMR [12246]	United Exchange	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Exchange	$24.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$19.20	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
UMR [12246]	United Healthcare	$19.20	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
UMR [12246]	United Healthcare	$20.15	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
UMR [12246]	United Healthcare	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
UMR [12246]	United Healthcare	$24.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Narrow Network	$423	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
UMR [12246]	United Narrow Network	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
UMR [12246]	United Narrow Network	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UMR [12246]	United Narrow Network	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
UMR [12246]	United PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
UMR [12246]	United PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UMR [12246]	United PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
UMR [12246]	United PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$19.20	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$19.20	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$20.15	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$24.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$423	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$19.20	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$19.20	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
UNITED HEALTHCARE [12201]	United HMO	$19.35	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
UNITED HEALTHCARE [12201]	United HMO	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$24.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$423	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$423	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$890	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
WEB TPA [11007]	Aetna	$17.46	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WEB TPA [11007]	Aetna PPO	$473	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
WEB TPA [11007]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WEB TPA [11007]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
WEB TPA [11007]	Aetna PPO	$997	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
WELFARE PENSION [13120]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
WELFARE PENSION [13120]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
WSHIP [13121]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
WSHIP [13121]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$17.91	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$20.48	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$25.60	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$25.60	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
ZENITH [13123]	First Choice PPO	$479	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
ZENITH [13123]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ZENITH [13123]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ZENITH [13123]	First Choice PPO	$1,008	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—

Medicaid managed care 111 prices

Rate for an Apple Health managed-care plan. Applies only to members of that plan.

Medicaid managed care prices for Forearm X-ray at Seattle Children's Hospital
Payer	Plan	Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
CHPW [15802]	CHPW Apple Health	$4.62	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
CHPW [15802]	CHPW Apple Health	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
CHPW [15802]	CHPW Apple Health	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
CHPW [15802]	CHPW Apple Health	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
CHPW [15802]	CHPW Apple Health	$16.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$146	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
CHPW [15802]	CHPW Apple Health	$308	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHPW [15802]	CHPW Apple Health	$308	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
CHPW [15802]	CHPW Apple Health	$308	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$4.71	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$12.10	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$12.10	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$15.12	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$149	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$149	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$4.94	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
ICW UHC [15812]	United Community Apple Health	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
ICW UHC [15812]	United Community Apple Health	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$16.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$149	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$4.71	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$12.10	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$12.10	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$15.12	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$149	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$4.71	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$12.10	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$12.10	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
KAISER [15818]	Molina Apple Health	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
KAISER [15818]	Molina Apple Health	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$15.12	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$145	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$305	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$305	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$305	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$4.71	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$12.10	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
MOLINA [15809]	Molina Apple Health	$12.10	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
MOLINA [15809]	Molina Apple Health	$15.12	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$145	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$305	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$305	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$305	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$149	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$183	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$386	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$386	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$386	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$4.94	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$16.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$183	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$386	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$386	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$386	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$4.94	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$16.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$149	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$4.71	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$12.10	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$12.10	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$15.12	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$149	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$314	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—

Medicaid (state program) 11 prices

Washington Apple Health fee-for-service. Applies only to Medicaid enrollees.

Medicaid (state program) prices for Forearm X-ray at Seattle Children's Hospital
Payer	Plan	Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
MEDICAID WA [14900]	Washington Medicaid	$4.49	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$11.52	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$11.52	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
MEDICAID WA [14900]	Washington Medicaid	$14.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
MEDICAID WA [14900]	Washington Medicaid	$14.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$14.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$14.40	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$142	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$299	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$299	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$299	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—

Other government program 11 prices

TRICARE, VA, Indian Health Service, workers' compensation, or another public program.

Other government program prices for Forearm X-ray at Seattle Children's Hospital
Payer	Plan	Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
USFHP [12208]	Pac Med	$9.25	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$17.92	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
USFHP [12208]	Pac Med	$17.92	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
USFHP [12208]	Pac Med	$22.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
USFHP [12208]	Pac Med	$22.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
USFHP [12208]	Pac Med	$22.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$22.40	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$231	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
USFHP [12208]	Pac Med	$486	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
USFHP [12208]	Pac Med	$486	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
USFHP [12208]	Pac Med	$486	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—

Unknown 113 prices

The source file doesn't say which population this rate applies to.

Unknown prices for Forearm X-ray at Seattle Children's Hospital
Payer	Plan	Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
AETNA [11000]	Aetna	$17.46	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASURIS [11900]	Regence Blue Shield	$16.68	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASURIS [11913]	Regence Blue Shield	$16.68	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$4.49	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$11.52	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$11.52	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$14.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$14.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$14.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$14.40	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$142	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$299	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$299	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$299	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
CIGNA [12204]	Cigna	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
CIGNA [12204]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna	$18.90	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$16.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$507	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$1,068	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$1,068	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$1,068	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$5.16	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$13.25	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$13.25	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$16.56	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$16.56	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$16.56	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$16.56	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$4.49	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$11.52	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
HOSPICE [17306]	Washington Medicaid	$11.52	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
HOSPICE [17306]	Washington Medicaid	$14.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
HOSPICE [17306]	Washington Medicaid	$14.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
HOSPICE [17306]	Washington Medicaid	$14.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$14.40	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$142	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
HOSPICE [17306]	Washington Medicaid	$299	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HOSPICE [17306]	Washington Medicaid	$299	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
HOSPICE [17306]	Washington Medicaid	$299	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser	$17.92	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
KAISER [13400]	Kaiser	$17.92	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser	$18.34	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$22.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser	$22.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$22.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
KAISER [13400]	Kaiser	$22.40	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$17.92	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
KAISER [13401]	Kaiser	$17.92	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser	$18.34	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$22.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser	$22.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$22.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
KAISER [13401]	Kaiser	$22.40	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$4.49	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$11.52	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$11.52	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$14.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$14.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$14.40	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$14.40	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$142	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$299	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$299	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$299	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna	$17.46	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$4.71	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$12.10	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
OPTICARE [15895]	Coordinated Care Vision	$12.10	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
OPTICARE [15895]	Coordinated Care Vision	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$15.12	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$15.12	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
PB CIGNA CRD [12283]	Cigna	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
PB CIGNA CRD [12283]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PB CIGNA CRD [12283]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
PB CIGNA CRD [12283]	Cigna	$18.90	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$16.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
PB PREMERA [11601]	Premera Blue Cross	$17.27	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PB REGENCE [11908]	Regence Blue Shield	$16.68	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera Blue Cross	$17.27	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$18.90	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$16.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Blue Shield	$16.68	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REGENCE [11909]	Regence Blue Shield	$16.68	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$12.80	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$16.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$18.90	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$16.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$496	Hospital’s fee	Xray Forearm 2v	percent of total billed charges	Outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$1,044	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$1,044	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE\|REPEAT PROCEDURE BY ANOTHER PHYSICIAN	percent of total billed charges	Outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$1,044	Hospital’s fee	Xray Forearm 2v\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$19.20	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Inpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$19.20	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$20.15	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE\|REDUCED SERVICES	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$24.00	Doctor’s fee	X-Ray Forearm\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$24.00	Hospital’s fee	X-Ray Forearm	percent of total billed charges	Inpatient or outpatient	—

Doctors here who do this procedure

No doctor affiliated with Seattle Children's Hospital billed Traditional Medicare for this often enough for CMS to publish it (11 or more patients a year). That doesn’t mean no one here does it. See all doctors and practices for this procedure.

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Seattle Children's Hospital

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1 Hospital's feeSent by the hospital

2 RadiologistSent by the radiology group

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Seattle Children's Hospital

Cash price 5 prices

List price (before discounts) 11 prices

Commercial insurance 732 prices

Medicaid managed care 111 prices

Medicaid (state program) 11 prices

Other government program 11 prices

Unknown 113 prices

Doctors here who do this procedure

Hospital's feeSent by the hospital

RadiologistSent by the radiology group