Seattle Children's Hospital

SeattleKing CountyChildrens

Leg CT scan without contrast

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

What you may pay

With insurance from an employer or private plan: $78.48 – $4,282At 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): $195 – $4,460The 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 and technologist	The hospital	Expected	Published by the hospital: the prices above	—	—
RadiologistReading the scan and writing the report	The radiology group	Expected	Billed separately; amount estimated	$50	$59 to $90
Ordering doctor's visitThe visit where the CT scan 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 $32 to $38 of about $162 to $192 billed to your plan.

Your share of the hospital's bill is about $20; 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.
$102
Your plan pays
$81.79
Your coinsurance
$20.45
You oweThe provider bills you this after the insurer pays.
$20.45
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.
$59.41
Your plan pays
$47.53
Your coinsurance
$11.88
You oweThe provider bills you this after the insurer pays.
$11.88

All bills: allowed amounts: $162
Your plan pays: $129
You owe in all: $32.33

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: leg ct scan without contrast at Seattle Children's Hospital

Hello,

I am planning a leg ct scan without contrast (billing code CPT 73700) 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 leg ct scan without 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).

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

Cash price 5 prices

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

Cash price prices for Leg CT scan without contrast at Seattle Children's Hospital
Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
$195	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	—	Outpatient	—
$293	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	—	Inpatient	—
$195	Hospital’s fee	CT Lower Extremity W/O Dye	—	Inpatient or outpatient	—
$2,230	Hospital’s fee	CT Ext Lower W/O Contra	—	Outpatient	—
$4,460	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	—	Outpatient	—

List price (before discounts) 8 prices

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

List price (before discounts) prices for Leg CT scan without contrast at Seattle Children's Hospital
Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
$195	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	—	Outpatient	—
$195	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	—	Inpatient or outpatient	—
$195	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	—	Inpatient or outpatient	—
$195	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	—	Inpatient or outpatient	—
$293	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	—	Inpatient	—
$195	Hospital’s fee	CT Lower Extremity W/O Dye	—	Inpatient or outpatient	—
$2,230	Hospital’s fee	CT Ext Lower W/O Contra	—	Outpatient	—
$4,460	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	—	Outpatient	—

Commercial insurance 500 prices

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

Commercial insurance prices for Leg CT scan without 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	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ADMINISTRATORS [13102]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$1,784	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$3,568	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$1,673	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$3,345	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
AETNA [11000]	Aetna PPO	$1,873	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
AETNA [11000]	Aetna PPO	$3,746	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$115	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$173	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ALLEGIANCE [12264]	Cigna	$97.50	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ALLIED [13129]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$2,141	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$4,282	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
AMERIBEN [11006]	Aetna	$107	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna	$161	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
AMERIBEN [11006]	Aetna PPO	$1,873	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
AMERIBEN [11006]	Aetna PPO	$3,746	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASURIS [11900]	Regence PPO	$1,851	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
ASURIS [11900]	Regence PPO	$3,702	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASURIS [11913]	Regence Exchange	$1,204	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
ASURIS [11913]	Regence Exchange	$2,408	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$1,851	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$3,702	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Blue Shield	$102	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Blue Shield	$153	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$1,204	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$2,408	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$78.48	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$118	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$97.50	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$1,227	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$2,453	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna	$107	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna	$161	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$1,873	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$3,746	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna Narrow Network	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna Narrow Network	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$234	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
CLARITEV [12299]	Multiplan	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan PPO	$2,119	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan PPO	$4,237	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$80.56	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$121	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$146	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$1,673	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$3,345	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$80.56	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$121	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$146	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$1,227	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$2,453	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CORESOURCE [11004]	Aetna	$107	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna	$161	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
CORESOURCE [11004]	Aetna PPO	$1,873	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
CORESOURCE [11004]	Aetna PPO	$3,746	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY FC [13112]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
COVENTRY FC [13112]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$2,141	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$4,282	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY [12244]	First Health PPO	$2,141	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
COVENTRY [12244]	First Health PPO	$4,282	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
EBMS FC [13144]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS [11003]	Aetna	$107	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EBMS [11003]	Aetna	$161	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
EBMS [11003]	Aetna PPO	$1,873	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
EBMS [11003]	Aetna PPO	$3,746	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$234	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
EBMS [12241]	Multiplan	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan PPO	$2,119	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan PPO	$4,237	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
FIRST CHOICE [13399]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
FIRST HEALTH [12210]	First Health PPO	$2,141	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
FIRST HEALTH [12210]	First Health PPO	$4,282	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HCC MEDICAL [12274]	First Health PPO	$2,141	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
HCC MEDICAL [12274]	First Health PPO	$4,282	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$234	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$2,119	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$4,237	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
HEALTH ALLIANCE [13233]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$234	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
HUMANA [12224]	Multiplan	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan PPO	$2,119	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan PPO	$4,237	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ILWU-PMA [13158]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser Exchange	$1,227	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser Exchange	$2,453	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser HMO	$1,450	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser HMO	$2,899	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser PPO	$1,673	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser PPO	$3,345	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser HMO	$1,450	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser HMO	$2,899	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$234	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$2,119	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$4,237	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KPS [13109]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
KPS [13109]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
LEWERMARK [12286]	First Health PPO	$2,141	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
LEWERMARK [12286]	First Health PPO	$4,282	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$234	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$2,119	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$4,237	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDISHARE [12287]	First Health PPO	$2,141	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
MEDISHARE [12287]	First Health PPO	$4,282	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEGA LIFE [13111]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
MEGA LIFE [13111]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
MERITAIN HEALTH [13229]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Aetna	$107	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MERITAIN [12251]	Aetna	$161	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
MERITAIN [12251]	Aetna PPO	$1,873	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Aetna PPO	$3,746	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$234	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
MERITAIN [12251]	Multiplan	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan PPO	$2,119	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan PPO	$4,237	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
MODA FC [13219]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna PPO	$1,873	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna PPO	$3,746	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$234	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
MODA [12842]	Multiplan	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan PPO	$2,119	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan PPO	$4,237	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$1,673	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$3,345	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$84.16	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$126	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$146	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$234	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$2,119	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$4,237	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$2,141	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$4,282	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$234	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
PEHP [12235]	Multiplan	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan PPO	$2,119	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan PPO	$4,237	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$2,007	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$4,014	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PERSONIFY FC [13155]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$115	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$173	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PERSONIFY [12270]	Cigna	$97.50	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREFERRED ONE [11008]	Aetna	$107	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna	$161	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PREFERRED ONE [11008]	Aetna PPO	$1,873	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$3,746	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$234	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$2,119	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$4,237	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera BC Heritage Prime	$105	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera BC Heritage Prime	$158	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PREMERA [11600]	Premera BC Heritage Signature/Lifewise	$105	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera BC Heritage Signature/Lifewise	$158	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PREMERA [11600]	Premera Exchange	$1,204	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Exchange	$2,408	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera HMO	$1,517	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera HMO	$3,033	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Narrow Network	$1,628	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Narrow Network	$3,256	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera PPO	$1,851	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera PPO	$3,702	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Public Option	$1,204	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Public Option	$2,408	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PSEW [13124]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
PSEW [13124]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE UMP [12263]	Regence UMP	$96.88	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$145	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
REGENCE UMP [12263]	Regence UMP	$1,450	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
REGENCE UMP [12263]	Regence UMP	$2,899	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence Exchange	$1,204	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence Exchange	$2,408	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence PPO	$1,851	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence PPO	$3,702	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11909]	Regence Exchange	$1,204	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
REGENCE [11909]	Regence Exchange	$2,408	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
REHN & ASSOCIATES [13182]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$2,141	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$4,282	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
SAMARITAN HEALTH [12265]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
SELECT HEALTH [12277]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$234	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
SELECT HEALTH [12277]	Multiplan	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$2,119	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$4,237	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
STARMARK [13103]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
TRUSTEED PLANS [13186]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UMR [12246]	United Exchange	$123	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UMR [12246]	United Exchange	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UMR [12246]	United Exchange	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Exchange	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Exchange	$184	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
UMR [12246]	United Exchange	$146	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$123	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UMR [12246]	United Healthcare	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$184	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
UMR [12246]	United Healthcare	$146	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Narrow Network	$1,673	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
UMR [12246]	United Narrow Network	$3,345	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UMR [12246]	United PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
UMR [12246]	United PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$123	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$184	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$146	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$1,673	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$3,345	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$118	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$177	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
UNITED HEALTHCARE [12201]	United HMO	$146	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$1,673	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$3,345	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$1,673	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$3,345	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WEB TPA [11007]	Aetna	$107	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WEB TPA [11007]	Aetna	$161	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
WEB TPA [11007]	Aetna PPO	$1,873	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
WEB TPA [11007]	Aetna PPO	$3,746	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
WELFARE PENSION [13120]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
WSHIP [13121]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$109	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$156	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$163	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$156	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ZENITH [13123]	First Choice PPO	$1,896	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
ZENITH [13123]	First Choice PPO	$3,791	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—

Medicaid managed care 78 prices

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

Medicaid managed care prices for Leg CT scan without 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	$27.73	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$41.59	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
CHPW [15802]	CHPW Apple Health	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHPW [15802]	CHPW Apple Health	$97.50	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$579	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
CHPW [15802]	CHPW Apple Health	$1,158	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$28.27	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$42.40	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$92.14	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$590	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$1,180	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$590	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$1,180	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$29.61	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$44.42	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ICW UHC [15812]	United Community Apple Health	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$97.50	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$590	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$1,180	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$28.27	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$42.40	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$92.14	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$590	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$1,180	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$28.27	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$42.40	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
KAISER [15818]	Molina Apple Health	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$92.14	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$573	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$1,146	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$28.27	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$42.40	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
MOLINA [15809]	Molina Apple Health	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$92.14	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$573	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$1,146	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$590	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$1,180	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$725	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$1,450	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$29.61	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$44.42	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$97.50	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$725	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$1,450	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$29.61	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$44.42	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$97.50	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$590	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$1,180	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$28.27	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$42.40	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$92.14	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$590	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$1,180	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—

Medicaid (state program) 8 prices

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

Medicaid (state program) prices for Leg CT scan without 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	$26.92	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$40.38	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
MEDICAID WA [14900]	Washington Medicaid	$87.75	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$87.75	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$87.75	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$87.75	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$562	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$1,124	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—

Other government program 8 prices

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

Other government program prices for Leg CT scan without 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	$56.41	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$84.62	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
USFHP [12208]	Pac Med	$137	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
USFHP [12208]	Pac Med	$137	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$137	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$137	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$914	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
USFHP [12208]	Pac Med	$1,829	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—

Unknown 100 prices

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

Unknown prices for Leg CT scan without 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	$107	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
AETNA [11000]	Aetna	$161	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ASURIS [11900]	Regence Blue Shield	$102	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASURIS [11900]	Regence Blue Shield	$153	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ASURIS [11913]	Regence Blue Shield	$102	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASURIS [11913]	Regence Blue Shield	$153	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$26.92	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$40.38	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$87.75	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$87.75	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$87.75	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$87.75	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$562	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$1,124	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$115	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$173	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
CIGNA [12204]	Cigna	$97.50	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$2,007	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$4,014	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$30.96	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$46.44	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$101	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$101	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$101	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$101	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$26.92	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$40.38	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
HOSPICE [17306]	Washington Medicaid	$87.75	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$87.75	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$87.75	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HOSPICE [17306]	Washington Medicaid	$87.75	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$562	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
HOSPICE [17306]	Washington Medicaid	$1,124	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser	$112	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$137	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser	$137	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$137	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$168	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
KAISER [13400]	Kaiser	$137	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$112	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$137	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$137	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser	$137	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$168	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
KAISER [13401]	Kaiser	$137	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$26.92	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$40.38	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$87.75	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$87.75	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$87.75	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$87.75	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$562	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$1,124	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna	$107	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MODA [11009]	Aetna	$161	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
OPTICARE [15895]	Coordinated Care Vision	$28.27	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$42.40	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
OPTICARE [15895]	Coordinated Care Vision	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$92.14	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$92.14	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PB CIGNA CRD [12283]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$115	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$173	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PB CIGNA CRD [12283]	Cigna	$97.50	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PB PREMERA [11601]	Premera Blue Cross	$105	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PB PREMERA [11601]	Premera Blue Cross	$158	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PB REGENCE [11908]	Regence Blue Shield	$102	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PB REGENCE [11908]	Regence Blue Shield	$153	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PREMERA [11600]	Premera Blue Cross	$105	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera Blue Cross	$158	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$115	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$173	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$97.50	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Blue Shield	$102	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REGENCE [11903]	Regence Blue Shield	$153	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
REGENCE [11909]	Regence Blue Shield	$102	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REGENCE [11909]	Regence Blue Shield	$153	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$97.50	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$115	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$173	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$97.50	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$1,963	Hospital’s fee	CT Ext Lower W/O Contra	percent of total billed charges	Outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$3,925	Hospital’s fee	CT Ext Lower W/O Contra\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$123	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$146	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$184	Doctor’s fee	CT Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$146	Hospital’s fee	CT Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—

Doctors here who do this procedure

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

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Seattle Children's Hospital

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1 Hospital's feeSent by the hospital

2 RadiologistSent by the radiology group

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Seattle Children's Hospital

Cash price 5 prices

List price (before discounts) 8 prices

Commercial insurance 500 prices

Medicaid managed care 78 prices

Medicaid (state program) 8 prices

Other government program 8 prices

Unknown 100 prices

Doctors here who do this procedure

Hospital's feeSent by the hospital

RadiologistSent by the radiology group