Seattle Children's Hospital

SeattleKing CountyChildrens

Arm or hand MRI without contrast (not a joint)

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

What you may pay

With insurance from an employer or private plan: $107 – $4,722At least one plan lists 6 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): $267 – $4,919The hospital lists 6 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 scan: equipment and technologist	The hospital	Expected	Published by the hospital: the prices above	—	—
RadiologistReading the scan and writing the report	The radiology group	Expected	Billed separately; amount estimated	$68	$81 to $122
Ordering doctor's visitThe visit where the MRI 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 $44 to $52 of about $218 to $260 billed to your plan.

Your share of the hospital's bill is about $28; 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.
$138
Your plan pays
$110
Your coinsurance
$27.55
You oweThe provider bills you this after the insurer pays.
$27.55
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.
$80.58
Your plan pays
$64.47
Your coinsurance
$16.12
You oweThe provider bills you this after the insurer pays.
$16.12

All bills: allowed amounts: $218
Your plan pays: $175
You owe in all: $43.67

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: arm or hand mri without contrast (not a joint) at Seattle Children's Hospital

Hello,

I am planning a arm or hand mri without contrast (not a joint) (billing code CPT 73218) 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 arm or hand mri without contrast (not a joint)."

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).

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

Cash price 7 prices

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

Cash price prices for Arm or hand MRI without contrast (not a joint) at Seattle Children's Hospital
Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
$267	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	—	Inpatient or outpatient	—
$267	Hospital’s fee	MRI Upper Extremity W/O Dye	—	Inpatient or outpatient	—
$1,305	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	—	Outpatient	—
$2,611	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	—	Outpatient	—
$2,953	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	—	Inpatient or outpatient	—
$4,382	Hospital’s fee	MRI Upper Ext W/O Contrast	—	Outpatient	—
$4,919	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	—	Inpatient or outpatient	—

List price (before discounts) 9 prices

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

List price (before discounts) prices for Arm or hand MRI without contrast (not a joint) at Seattle Children's Hospital
Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
$265	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	—	Inpatient or outpatient	—
$267	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	—	Inpatient or outpatient	—
$267	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	—	Inpatient or outpatient	—
$267	Hospital’s fee	MRI Upper Extremity W/O Dye	—	Inpatient or outpatient	—
$1,305	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	—	Outpatient	—
$2,611	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	—	Outpatient	—
$2,953	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	—	Inpatient or outpatient	—
$4,382	Hospital’s fee	MRI Upper Ext W/O Contrast	—	Outpatient	—
$4,919	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	—	Inpatient or outpatient	—

Commercial insurance 689 prices

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

Commercial insurance prices for Arm or hand MRI without contrast (not a joint) 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	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$1,044	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$2,089	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$2,362	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$3,505	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$3,935	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$979	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$1,958	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$2,215	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$3,286	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$3,689	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
AETNA [11000]	Aetna PPO	$1,097	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
AETNA [11000]	Aetna PPO	$2,193	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
AETNA [11000]	Aetna PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
AETNA [11000]	Aetna PPO	$3,681	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
AETNA [11000]	Aetna PPO	$4,132	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$158	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$134	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$1,253	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$2,506	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$2,835	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$4,207	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$4,722	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna	$145	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna PPO	$1,097	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
AMERIBEN [11006]	Aetna PPO	$2,193	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
AMERIBEN [11006]	Aetna PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna PPO	$3,681	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
AMERIBEN [11006]	Aetna PPO	$4,132	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11900]	Regence PPO	$1,083	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ASURIS [11900]	Regence PPO	$2,167	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASURIS [11900]	Regence PPO	$2,451	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11900]	Regence PPO	$3,637	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
ASURIS [11900]	Regence PPO	$4,083	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11913]	Regence Exchange	$705	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ASURIS [11913]	Regence Exchange	$1,410	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASURIS [11913]	Regence Exchange	$1,595	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11913]	Regence Exchange	$2,366	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
ASURIS [11913]	Regence Exchange	$2,656	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$1,083	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$2,167	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$2,451	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$3,637	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$4,083	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Blue Shield	$138	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$705	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$1,410	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$1,595	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$2,366	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$2,656	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$107	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$134	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$718	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$1,436	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$1,624	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$2,410	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$2,706	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna	$145	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$1,097	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$2,193	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$3,681	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$4,132	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna Narrow Network	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna Narrow Network	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna Narrow Network	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna Narrow Network	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna Narrow Network	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$212	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan PPO	$1,240	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan PPO	$2,805	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan PPO	$4,163	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan PPO	$4,673	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$109	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$200	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$200	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$200	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$979	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$1,958	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$2,215	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$3,286	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$3,689	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$109	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$200	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$200	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$200	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$718	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$1,436	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$1,624	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$2,410	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$2,706	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna	$145	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna PPO	$1,097	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CORESOURCE [11004]	Aetna PPO	$2,193	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CORESOURCE [11004]	Aetna PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna PPO	$3,681	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
CORESOURCE [11004]	Aetna PPO	$4,132	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COVENTRY FC [13112]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
COVENTRY FC [13112]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY FC [13112]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
COVENTRY FC [13112]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
COVENTRY FC [13112]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$1,253	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$2,506	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$2,835	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$4,207	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$4,722	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COVENTRY [12244]	First Health PPO	$1,253	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
COVENTRY [12244]	First Health PPO	$2,506	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY [12244]	First Health PPO	$2,835	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
COVENTRY [12244]	First Health PPO	$4,207	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
COVENTRY [12244]	First Health PPO	$4,722	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EBMS [11003]	Aetna	$145	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EBMS [11003]	Aetna PPO	$1,097	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
EBMS [11003]	Aetna PPO	$2,193	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS [11003]	Aetna PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
EBMS [11003]	Aetna PPO	$3,681	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
EBMS [11003]	Aetna PPO	$4,132	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$212	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan PPO	$1,240	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan PPO	$2,805	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan PPO	$4,163	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan PPO	$4,673	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
FIRST HEALTH [12210]	First Health PPO	$1,253	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
FIRST HEALTH [12210]	First Health PPO	$2,506	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
FIRST HEALTH [12210]	First Health PPO	$2,835	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
FIRST HEALTH [12210]	First Health PPO	$4,207	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
FIRST HEALTH [12210]	First Health PPO	$4,722	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HCC MEDICAL [12274]	First Health PPO	$1,253	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
HCC MEDICAL [12274]	First Health PPO	$2,506	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HCC MEDICAL [12274]	First Health PPO	$2,835	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
HCC MEDICAL [12274]	First Health PPO	$4,207	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
HCC MEDICAL [12274]	First Health PPO	$4,722	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$212	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$1,240	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$2,805	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$4,163	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$4,673	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$212	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan PPO	$1,240	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan PPO	$2,805	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan PPO	$4,163	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan PPO	$4,673	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser Exchange	$718	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser Exchange	$1,436	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser Exchange	$1,624	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser Exchange	$2,410	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser Exchange	$2,706	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser HMO	$849	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser HMO	$1,697	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser HMO	$1,919	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser HMO	$2,848	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser HMO	$3,197	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser PPO	$979	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser PPO	$1,958	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser PPO	$2,215	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser PPO	$3,286	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser PPO	$3,689	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser HMO	$849	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser HMO	$1,697	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser HMO	$1,919	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser HMO	$2,848	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser HMO	$3,197	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$212	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$1,240	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$2,805	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$4,163	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$4,673	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KPS [13109]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
KPS [13109]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KPS [13109]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
KPS [13109]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
KPS [13109]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
LEWERMARK [12286]	First Health PPO	$1,253	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
LEWERMARK [12286]	First Health PPO	$2,506	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
LEWERMARK [12286]	First Health PPO	$2,835	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
LEWERMARK [12286]	First Health PPO	$4,207	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
LEWERMARK [12286]	First Health PPO	$4,722	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$212	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$1,240	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$2,805	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$4,163	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$4,673	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEDISHARE [12287]	First Health PPO	$1,253	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MEDISHARE [12287]	First Health PPO	$2,506	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDISHARE [12287]	First Health PPO	$2,835	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
MEDISHARE [12287]	First Health PPO	$4,207	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
MEDISHARE [12287]	First Health PPO	$4,722	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEGA LIFE [13111]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MEGA LIFE [13111]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEGA LIFE [13111]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
MEGA LIFE [13111]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
MEGA LIFE [13111]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Aetna	$145	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MERITAIN [12251]	Aetna PPO	$1,097	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Aetna PPO	$2,193	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Aetna PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Aetna PPO	$3,681	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Aetna PPO	$4,132	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$212	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan PPO	$1,240	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan PPO	$2,805	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan PPO	$4,163	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan PPO	$4,673	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA [11009]	Aetna PPO	$1,097	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna PPO	$2,193	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
MODA [11009]	Aetna PPO	$3,681	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna PPO	$4,132	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$212	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan PPO	$1,240	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan PPO	$2,805	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan PPO	$4,163	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan PPO	$4,673	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$979	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$1,958	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$2,215	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$3,286	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$3,689	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$114	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$200	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$200	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$200	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$212	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$1,240	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$2,805	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$4,163	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$4,673	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$1,253	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$2,506	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$2,835	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$4,207	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$4,722	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$212	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan PPO	$1,240	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan PPO	$2,805	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan PPO	$4,163	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan PPO	$4,673	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$1,175	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$2,350	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$2,658	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$3,944	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$4,427	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$158	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$134	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna	$145	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$1,097	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$2,193	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$3,681	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$4,132	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$212	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$1,240	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$2,805	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$4,163	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$4,673	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera BC Heritage Prime	$143	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera BC Heritage Signature/Lifewise	$143	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera Exchange	$705	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Exchange	$1,410	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Exchange	$1,595	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Exchange	$2,366	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Exchange	$2,656	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera HMO	$888	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera HMO	$1,775	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera HMO	$2,008	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera HMO	$2,980	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera HMO	$3,345	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Narrow Network	$953	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Narrow Network	$1,906	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Narrow Network	$2,156	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Narrow Network	$3,199	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Narrow Network	$3,591	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera PPO	$1,083	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera PPO	$2,167	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera PPO	$2,451	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera PPO	$3,637	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera PPO	$4,083	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Public Option	$705	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Public Option	$1,410	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Public Option	$1,595	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Public Option	$2,366	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Public Option	$2,656	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PSEW [13124]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PSEW [13124]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PSEW [13124]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
PSEW [13124]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
PSEW [13124]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$131	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$849	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
REGENCE UMP [12263]	Regence UMP	$1,697	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE UMP [12263]	Regence UMP	$1,919	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$2,848	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
REGENCE UMP [12263]	Regence UMP	$3,197	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Exchange	$705	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence Exchange	$1,410	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence Exchange	$1,595	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Exchange	$2,366	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence Exchange	$2,656	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence PPO	$1,083	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence PPO	$2,167	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence PPO	$2,451	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence PPO	$3,637	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence PPO	$4,083	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11909]	Regence Exchange	$705	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
REGENCE [11909]	Regence Exchange	$1,410	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11909]	Regence Exchange	$1,595	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11909]	Regence Exchange	$2,366	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
REGENCE [11909]	Regence Exchange	$2,656	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$1,253	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$2,506	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$2,835	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$4,207	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$4,722	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$212	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$1,240	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$2,805	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$4,163	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$4,673	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Exchange	$168	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UMR [12246]	United Exchange	$200	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Exchange	$200	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Exchange	$200	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$168	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$200	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$200	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$200	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Narrow Network	$979	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UMR [12246]	United Narrow Network	$1,958	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UMR [12246]	United Narrow Network	$2,215	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Narrow Network	$3,286	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
UMR [12246]	United Narrow Network	$3,689	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UMR [12246]	United PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UMR [12246]	United PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
UMR [12246]	United PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$168	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$200	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$200	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$200	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$979	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$1,958	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$2,215	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$3,286	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$3,689	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$162	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$200	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$200	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$200	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$979	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$1,958	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$2,215	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$3,286	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$3,689	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$979	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$1,958	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$2,215	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$3,286	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$3,689	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WEB TPA [11007]	Aetna	$145	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WEB TPA [11007]	Aetna PPO	$1,097	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
WEB TPA [11007]	Aetna PPO	$2,193	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WEB TPA [11007]	Aetna PPO	$2,480	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
WEB TPA [11007]	Aetna PPO	$3,681	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
WEB TPA [11007]	Aetna PPO	$4,132	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$149	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$214	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$214	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ZENITH [13123]	First Choice PPO	$1,110	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ZENITH [13123]	First Choice PPO	$2,219	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ZENITH [13123]	First Choice PPO	$2,510	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
ZENITH [13123]	First Choice PPO	$3,725	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
ZENITH [13123]	First Choice PPO	$4,181	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—

Medicaid managed care 96 prices

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

Medicaid managed care prices for Arm or hand MRI without contrast (not a joint) 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	$37.92	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$134	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$339	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CHPW [15802]	CHPW Apple Health	$678	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHPW [15802]	CHPW Apple Health	$766	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$1,137	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
CHPW [15802]	CHPW Apple Health	$1,277	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$38.66	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$126	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$126	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$126	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$345	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$691	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$781	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$1,159	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$1,302	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$345	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$691	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$781	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$1,159	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$1,302	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$40.50	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$134	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$345	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$691	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$781	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$1,159	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$1,302	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$38.66	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$126	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$126	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$126	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$345	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$691	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$781	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$1,159	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$1,302	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$38.66	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$126	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$126	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$126	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$336	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$671	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$759	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$1,126	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$1,264	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$38.66	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$126	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$126	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$126	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$336	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$671	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$759	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$1,126	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$1,264	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$345	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$691	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$781	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$1,159	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$1,302	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$424	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$849	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$960	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$1,424	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$1,599	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$40.50	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$134	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$424	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$849	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$960	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$1,424	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$1,599	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$40.50	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$134	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$345	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$691	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$781	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$1,159	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$1,302	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$38.66	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$126	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$126	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$126	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$345	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$691	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$781	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$1,159	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$1,302	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—

Medicaid (state program) 9 prices

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

Medicaid (state program) prices for Arm or hand MRI without contrast (not a joint) 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	$36.82	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$120	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$120	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$120	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$329	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$658	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$744	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$1,104	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$1,240	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—

Other government program 9 prices

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

Other government program prices for Arm or hand MRI without contrast (not a joint) 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	$76.97	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$187	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$187	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$187	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$535	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
USFHP [12208]	Pac Med	$1,070	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
USFHP [12208]	Pac Med	$1,211	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$1,797	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
USFHP [12208]	Pac Med	$2,017	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—

Unknown 82 prices

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

Unknown prices for Arm or hand MRI without contrast (not a joint) 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	$145	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASURIS [11900]	Regence Blue Shield	$138	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASURIS [11913]	Regence Blue Shield	$138	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$36.82	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$120	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$120	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$120	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$329	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$658	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$744	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$1,104	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$1,240	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$158	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$134	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$1,175	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$2,350	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$2,658	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$3,944	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$4,427	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$42.34	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$138	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$138	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$138	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$36.82	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$120	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$120	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$120	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$329	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
HOSPICE [17306]	Washington Medicaid	$658	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HOSPICE [17306]	Washington Medicaid	$744	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$1,104	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
HOSPICE [17306]	Washington Medicaid	$1,240	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$153	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$187	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$187	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$187	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$153	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$187	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$187	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$187	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$36.82	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$120	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$120	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$120	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$329	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$658	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$744	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$1,104	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$1,240	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA [11009]	Aetna	$145	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$38.66	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$126	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$126	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$126	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$158	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$134	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PB PREMERA [11601]	Premera Blue Cross	$143	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PB REGENCE [11908]	Regence Blue Shield	$138	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera Blue Cross	$143	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$158	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$134	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Blue Shield	$138	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REGENCE [11909]	Regence Blue Shield	$138	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$134	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$158	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$134	Hospital’s fee	MRI Upper Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$1,149	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$2,298	Hospital’s fee	MRI Upper Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$2,598	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd	percent of total billed charges	Inpatient or outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$3,856	Hospital’s fee	MRI Upper Ext W/O Contrast	percent of total billed charges	Outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$4,329	Hospital’s fee	MRI Upper Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$168	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$200	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$200	Doctor’s fee	MRI Upper Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$200	Hospital’s fee	MRI Upper Extremity W/O Dye	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 7 prices

List price (before discounts) 9 prices

Commercial insurance 689 prices

Medicaid managed care 96 prices

Medicaid (state program) 9 prices

Other government program 9 prices

Unknown 82 prices

Doctors here who do this procedure

Hospital's feeSent by the hospital

RadiologistSent by the radiology group