Seattle Children's Hospital

SeattleKing CountyChildrens

Shoulder, elbow or wrist MRI with contrast

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

What you may pay

With insurance from an employer or private plan: $128 – $4,724At least one plan lists 3 separate amounts for this procedure. They may be parts of one bill that you pay together (for example the hospital’s fee and the fee of the doctor who reads a scan) or alternatives (inpatient or outpatient). We don’t show one price or compare it until we can tell which; every line is listed below. Ask the hospital which lines apply to you.
Paying yourself (cash price): $320 – $4,921The hospital lists 3 separate amounts for this procedure. They may be parts of one bill that you pay together (for example the hospital’s fee and the fee of the doctor who reads a scan) or alternatives (inpatient or outpatient). We don’t show one price or compare it until we can tell which; every line is listed below. Ask the hospital which lines apply to you.

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

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

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

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

Bills to expect

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

Separate bills for this procedure and their estimated amounts
Bill	Who sends it	How likely	Status	Traditional Medicare allows	Private plans (estimate)
Hospital's feeThe scan: equipment, technologist and contrast dye	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	$82	$97 to $146
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 $53 to $63 of about $264 to $314 billed to your plan.

Your share of the hospital's bill is about $34; 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.
$168
Your plan pays
$134
Your coinsurance
$33.50
You oweThe provider bills you this after the insurer pays.
$33.50
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.
$96.50
Your plan pays
$77.20
Your coinsurance
$19.30
You oweThe provider bills you this after the insurer pays.
$19.30

All bills: allowed amounts: $264
Your plan pays: $211
You owe in all: $52.80

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: shoulder, elbow or wrist mri with contrast at Seattle Children's Hospital

Hello,

I am planning a shoulder, elbow or wrist mri with contrast (billing code CPT 73222) 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 shoulder, elbow or wrist mri with contrast."

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).

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

Cash price 4 prices

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

Cash price prices for Shoulder, elbow or wrist MRI with contrast at Seattle Children's Hospital
Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
$320	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	—	Inpatient or outpatient	—
$4,683	Hospital’s fee	MRI Arthrogram Shoulder	—	Inpatient or outpatient	—
$4,683	Hospital’s fee	MRI Arthrogram Elbow	—	Inpatient or outpatient	—
$4,921	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	—	Outpatient	—

List price (before discounts) 7 prices

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

List price (before discounts) prices for Shoulder, elbow or wrist MRI with contrast at Seattle Children's Hospital
Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
$318	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	—	Inpatient or outpatient	—
$320	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	—	Inpatient or outpatient	—
$320	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	—	Inpatient or outpatient	—
$320	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	—	Inpatient or outpatient	—
$4,683	Hospital’s fee	MRI Arthrogram Elbow	—	Inpatient or outpatient	—
$4,683	Hospital’s fee	MRI Arthrogram Shoulder	—	Inpatient or outpatient	—
$4,921	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	—	Outpatient	—

Commercial insurance 493 prices

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

Commercial insurance prices for Shoulder, elbow or wrist MRI with contrast 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	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$3,747	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$3,747	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$3,937	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$3,512	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$3,512	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$3,691	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
AETNA [11000]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
AETNA [11000]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
AETNA [11000]	Aetna PPO	$4,133	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$189	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$160	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$4,724	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
AMERIBEN [11006]	Aetna	$175	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna PPO	$4,133	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
ASURIS [11900]	Regence PPO	$3,887	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11900]	Regence PPO	$3,887	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11900]	Regence PPO	$4,084	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
ASURIS [11913]	Regence Exchange	$2,529	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11913]	Regence Exchange	$2,529	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11913]	Regence Exchange	$2,657	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$3,887	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$3,887	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$4,084	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Blue Shield	$168	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$2,529	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$2,529	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$2,657	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$128	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$160	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$2,576	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$2,576	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$2,706	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna	$175	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$4,133	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna Narrow Network	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna Narrow Network	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna Narrow Network	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan	$254	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan PPO	$4,675	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$131	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$240	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$240	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$240	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$3,512	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$3,512	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$3,691	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$131	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$240	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$240	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$240	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$2,576	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$2,576	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$2,706	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
CORESOURCE [11004]	Aetna	$175	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna PPO	$4,133	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
COVENTRY FC [13112]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
COVENTRY FC [13112]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
COVENTRY FC [13112]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$4,724	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
COVENTRY [12244]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
COVENTRY [12244]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
COVENTRY [12244]	First Health PPO	$4,724	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
EBMS [11003]	Aetna	$175	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EBMS [11003]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
EBMS [11003]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
EBMS [11003]	Aetna PPO	$4,133	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan	$254	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan PPO	$4,675	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
FIRST HEALTH [12210]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
FIRST HEALTH [12210]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
FIRST HEALTH [12210]	First Health PPO	$4,724	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
HCC MEDICAL [12274]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
HCC MEDICAL [12274]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
HCC MEDICAL [12274]	First Health PPO	$4,724	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$254	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$4,675	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan	$254	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan PPO	$4,675	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser Exchange	$2,576	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser Exchange	$2,576	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser Exchange	$2,706	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser HMO	$3,044	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser HMO	$3,044	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser HMO	$3,199	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser PPO	$3,512	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser PPO	$3,512	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser PPO	$3,691	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser HMO	$3,044	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser HMO	$3,044	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser HMO	$3,199	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$254	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$4,675	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
KPS [13109]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
KPS [13109]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
KPS [13109]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
LEWERMARK [12286]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
LEWERMARK [12286]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
LEWERMARK [12286]	First Health PPO	$4,724	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$254	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$4,675	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
MEDISHARE [12287]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
MEDISHARE [12287]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
MEDISHARE [12287]	First Health PPO	$4,724	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
MEGA LIFE [13111]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
MEGA LIFE [13111]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
MEGA LIFE [13111]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Aetna	$175	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MERITAIN [12251]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Aetna PPO	$4,133	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan	$254	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan PPO	$4,675	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
MODA [11009]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
MODA [11009]	Aetna PPO	$4,133	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan	$254	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan PPO	$4,675	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$3,512	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$3,512	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$3,691	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$137	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$240	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$240	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$240	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$254	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$4,675	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$4,724	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan	$254	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan PPO	$4,675	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$4,215	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$4,215	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$4,429	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$189	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$160	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PREFERRED ONE [11008]	Aetna	$175	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$4,133	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$254	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$4,675	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera BC Heritage Prime	$172	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera BC Heritage Signature/Lifewise	$172	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera Exchange	$2,529	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Exchange	$2,529	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Exchange	$2,657	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera HMO	$3,185	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera HMO	$3,185	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera HMO	$3,346	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Narrow Network	$3,419	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Narrow Network	$3,419	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Narrow Network	$3,592	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera PPO	$3,887	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera PPO	$3,887	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera PPO	$4,084	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Public Option	$2,529	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Public Option	$2,529	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Public Option	$2,657	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
PSEW [13124]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
PSEW [13124]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
PSEW [13124]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
REGENCE UMP [12263]	Regence UMP	$159	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$3,044	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$3,044	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$3,199	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence Exchange	$2,529	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Exchange	$2,529	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Exchange	$2,657	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence PPO	$3,887	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence PPO	$3,887	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence PPO	$4,084	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
REGENCE [11909]	Regence Exchange	$2,529	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11909]	Regence Exchange	$2,529	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11909]	Regence Exchange	$2,657	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$4,496	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$4,724	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$254	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$4,449	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$4,675	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
UMR [12246]	United Exchange	$202	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UMR [12246]	United Exchange	$240	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Exchange	$240	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Exchange	$240	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$202	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$240	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$240	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$240	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Narrow Network	$3,512	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Narrow Network	$3,512	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Narrow Network	$3,691	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
UMR [12246]	United PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$202	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$240	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$240	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$240	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$3,512	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$3,512	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$3,691	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$194	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$240	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$240	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$240	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$3,512	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$3,512	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$3,691	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$3,512	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$3,512	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$3,691	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
WEB TPA [11007]	Aetna	$175	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WEB TPA [11007]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
WEB TPA [11007]	Aetna PPO	$3,934	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
WEB TPA [11007]	Aetna PPO	$4,133	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$178	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$256	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$256	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
ZENITH [13123]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
ZENITH [13123]	First Choice PPO	$3,981	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
ZENITH [13123]	First Choice PPO	$4,183	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—

Medicaid managed care 72 prices

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

Medicaid managed care prices for Shoulder, elbow or wrist MRI with contrast 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	$45.43	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$160	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$1,216	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$1,216	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$1,277	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$46.32	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$151	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$151	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$151	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$1,239	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$1,239	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$1,302	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$1,239	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$1,239	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$1,302	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$48.52	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$160	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$1,239	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$1,239	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$1,302	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$46.32	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$151	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$151	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$151	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$1,239	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$1,239	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$1,302	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$46.32	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$151	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$151	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$151	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$1,204	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$1,204	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$1,265	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$46.32	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$151	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$151	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$151	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$1,204	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$1,204	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$1,265	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$1,239	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$1,239	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$1,302	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$1,522	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$1,522	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$1,600	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$48.52	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$160	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$1,522	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$1,522	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$1,600	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$48.52	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$160	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$1,239	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$1,239	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$1,302	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$46.32	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$151	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$151	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$151	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$1,239	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$1,239	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$1,302	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—

Medicaid (state program) 7 prices

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

Medicaid (state program) prices for Shoulder, elbow or wrist MRI with contrast 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	$44.11	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$144	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$144	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$144	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$1,180	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$1,180	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$1,240	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—

Other government program 7 prices

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

Other government program prices for Shoulder, elbow or wrist MRI with contrast 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	$92.30	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$224	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$224	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$224	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$1,920	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$1,920	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$2,018	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—

Unknown 72 prices

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

Unknown prices for Shoulder, elbow or wrist MRI with contrast 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	$175	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASURIS [11900]	Regence Blue Shield	$168	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASURIS [11913]	Regence Blue Shield	$168	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$44.11	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$144	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$144	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$144	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$1,180	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$1,180	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$1,240	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$189	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$160	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$4,215	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$4,215	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$4,429	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$50.73	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$166	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$166	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$166	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$44.11	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$144	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$144	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$144	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$1,180	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$1,180	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$1,240	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser	$184	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$224	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$224	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$224	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$184	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$224	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$224	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$224	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$44.11	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$144	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$144	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$144	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$1,180	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$1,180	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$1,240	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna	$175	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$46.32	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$151	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$151	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$151	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$189	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$160	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
PB PREMERA [11601]	Premera Blue Cross	$172	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PB REGENCE [11908]	Regence Blue Shield	$168	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera Blue Cross	$172	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$189	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$160	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Blue Shield	$168	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REGENCE [11909]	Regence Blue Shield	$168	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$160	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$189	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$160	Hospital’s fee	MRI Joint Upr Extrem W/ Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$4,121	Hospital’s fee	MRI Arthrogram Shoulder	percent of total billed charges	Inpatient or outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$4,121	Hospital’s fee	MRI Arthrogram Elbow	percent of total billed charges	Inpatient or outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$4,330	Hospital’s fee	MRI Joint Upper Ext W/ Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$202	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$240	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$240	Doctor’s fee	MRI Joint Upr Extrem W/ Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$240	Hospital’s fee	MRI Joint Upr Extrem W/ 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.

See a price that looks wrong? Tell us about it.

Seattle Children's Hospital

What you may pay

Bills to expect

What you’d pay for these bills

How each bill comes to you

1 Hospital's feeSent by the hospital

2 RadiologistSent by the radiology group

Get it confirmed before your care

Seattle Children's Hospital

Cash price 4 prices

List price (before discounts) 7 prices

Commercial insurance 493 prices

Medicaid managed care 72 prices

Medicaid (state program) 7 prices

Other government program 7 prices

Unknown 72 prices

Doctors here who do this procedure

Hospital's feeSent by the hospital

RadiologistSent by the radiology group