Seattle Children's Hospital

SeattleKing CountyChildrens

Leg or foot MRI without contrast (not a joint)

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

What you may pay

With insurance from an employer or private plan: $106 – $8,584At least one plan lists 6 separate amounts for this procedure. They may be parts of one bill that you pay together (for example the hospital’s fee and the fee of the doctor who reads a scan) or alternatives (inpatient or outpatient). We don’t show one price or compare it until we can tell which; every line is listed below. Ask the hospital which lines apply to you.
Paying yourself (cash price): $265 – $8,942The hospital lists 6 separate amounts for this procedure. They may be parts of one bill that you pay together (for example the hospital’s fee and the fee of the doctor who reads a scan) or alternatives (inpatient or outpatient). We don’t show one price or compare it until we can tell which; every line is listed below. Ask the hospital which lines apply to you.

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

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

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

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

Bills to expect

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

Separate bills for this procedure and their estimated amounts
Bill	Who sends it	How likely	Status	Traditional Medicare allows	Private plans (estimate)
Hospital's feeThe scan: equipment and technologist	The hospital	Expected	Published by the hospital: the prices above	—	—
RadiologistReading the scan and writing the report	The radiology group	Expected	Billed separately; amount estimated	$67	$80 to $121
Ordering doctor's visitThe visit where the MRI is ordered or the results are explained	Your doctor	Possible	Billed separately; not priced	—	—

What you’d pay for these bills

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

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

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

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

The hospital's billHow your plan charges

The bill from the doctor doing the procedureHow your plan charges

You pay about $43 to $52 of about $217 to $258 billed to your plan.

Your share of the hospital's bill is about $27; 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.
$137
Your plan pays
$110
Your coinsurance
$27.41
You oweThe provider bills you this after the insurer pays.
$27.41
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.
$79.61
Your plan pays
$63.69
Your coinsurance
$15.92
You oweThe provider bills you this after the insurer pays.
$15.92

All bills: allowed amounts: $217
Your plan pays: $173
You owe in all: $43.33

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 or foot mri without contrast (not a joint) at Seattle Children's Hospital

Hello,

I am planning a leg or foot mri without contrast (not a joint) (billing code CPT 73718) 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 or foot mri without contrast (not a joint)."

I’ve sent this one

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

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

1,183 published prices, grouped by who each price applies to.

Cash price 9 prices

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

Cash price prices for Leg or foot MRI without contrast (not a joint) at Seattle Children's Hospital
Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
$265	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	—	Outpatient	—
$398	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	—	Inpatient	—
$265	Hospital’s fee	MRI Lower Extremity W/O Dye	—	Inpatient or outpatient	—
$1,457	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	—	Outpatient	—
$2,614	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	—	Outpatient	—
$2,913	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	—	Outpatient	—
$4,471	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	—	Outpatient	—
$4,471	Hospital’s fee	MRI Lower Ext W/O Contrast	—	Outpatient	—
$8,942	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	—	Outpatient	—

List price (before discounts) 12 prices

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

List price (before discounts) prices for Leg or foot MRI without contrast (not a joint) at Seattle Children's Hospital
Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
$265	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	—	Inpatient or outpatient	—
$265	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	—	Inpatient or outpatient	—
$265	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	—	Outpatient	—
$265	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	—	Inpatient or outpatient	—
$398	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	—	Inpatient	—
$265	Hospital’s fee	MRI Lower Extremity W/O Dye	—	Inpatient or outpatient	—
$1,457	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	—	Outpatient	—
$2,614	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	—	Outpatient	—
$2,913	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	—	Outpatient	—
$4,471	Hospital’s fee	MRI Lower Ext W/O Contrast	—	Outpatient	—
$4,471	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	—	Outpatient	—
$8,942	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	—	Outpatient	—

Commercial insurance 892 prices

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

Commercial insurance prices for Leg or foot MRI without contrast (not a joint) at Seattle Children's Hospital
Payer	Plan	Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
ADMINISTRATORS [13102]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ADMINISTRATORS [13102]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$1,165	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$2,092	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$2,331	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$3,577	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$3,577	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$7,154	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$1,093	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$1,961	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$2,185	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$3,353	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$3,353	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$6,707	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$212	Doctor’s fee	MRI 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	$212	Doctor’s fee	MRI 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	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
AETNA [11000]	Aetna PPO	$1,224	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
AETNA [11000]	Aetna PPO	$2,196	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
AETNA [11000]	Aetna PPO	$2,447	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
AETNA [11000]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
AETNA [11000]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
AETNA [11000]	Aetna PPO	$7,511	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$157	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$236	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ALLEGIANCE [12264]	Cigna	$133	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ALLIED [13129]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALLIED [13129]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$1,398	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$2,510	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$2,797	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$8,584	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
AMERIBEN [11006]	Aetna	$144	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna	$216	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
AMERIBEN [11006]	Aetna PPO	$1,224	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
AMERIBEN [11006]	Aetna PPO	$2,196	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
AMERIBEN [11006]	Aetna PPO	$2,447	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
AMERIBEN [11006]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
AMERIBEN [11006]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
AMERIBEN [11006]	Aetna PPO	$7,511	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASURIS [11900]	Regence PPO	$1,209	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ASURIS [11900]	Regence PPO	$2,170	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
ASURIS [11900]	Regence PPO	$2,418	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASURIS [11900]	Regence PPO	$3,711	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
ASURIS [11900]	Regence PPO	$3,711	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASURIS [11900]	Regence PPO	$7,422	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASURIS [11913]	Regence Exchange	$787	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ASURIS [11913]	Regence Exchange	$1,412	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
ASURIS [11913]	Regence Exchange	$1,573	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASURIS [11913]	Regence Exchange	$2,414	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
ASURIS [11913]	Regence Exchange	$2,414	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ASURIS [11913]	Regence Exchange	$4,829	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$1,209	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$2,170	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$2,418	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$3,711	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$3,711	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$7,422	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Blue Shield	$137	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Blue Shield	$206	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$787	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$1,412	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$1,573	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$2,414	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$2,414	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$4,829	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$106	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$160	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$133	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$801	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$1,438	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$1,602	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$2,459	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$2,459	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$4,918	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna	$144	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna	$216	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$1,224	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$2,196	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$2,447	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$7,511	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna Narrow Network	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna Narrow Network	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna Narrow Network	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna Narrow Network	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna Narrow Network	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna Narrow Network	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$318	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
CLARITEV [12299]	Multiplan	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan PPO	$1,384	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan PPO	$2,484	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan PPO	$2,768	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
CLARITEV [12299]	Multiplan PPO	$8,495	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$108	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$162	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$199	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$1,093	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$1,961	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$2,185	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$3,353	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$3,353	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$6,707	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$108	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$162	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$199	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$801	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$1,438	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$1,602	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$2,459	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$2,459	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$4,918	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CORESOURCE [11004]	Aetna	$144	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna	$216	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
CORESOURCE [11004]	Aetna PPO	$1,224	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CORESOURCE [11004]	Aetna PPO	$2,196	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
CORESOURCE [11004]	Aetna PPO	$2,447	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CORESOURCE [11004]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
CORESOURCE [11004]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CORESOURCE [11004]	Aetna PPO	$7,511	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY FC [13112]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
COVENTRY FC [13112]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
COVENTRY FC [13112]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY FC [13112]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY FC [13112]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
COVENTRY FC [13112]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$1,398	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$2,510	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$2,797	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$8,584	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY [12244]	First Health PPO	$1,398	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
COVENTRY [12244]	First Health PPO	$2,510	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
COVENTRY [12244]	First Health PPO	$2,797	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY [12244]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COVENTRY [12244]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
COVENTRY [12244]	First Health PPO	$8,584	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
EBMS FC [13144]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS FC [13144]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS [11003]	Aetna	$144	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EBMS [11003]	Aetna	$216	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
EBMS [11003]	Aetna PPO	$1,224	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
EBMS [11003]	Aetna PPO	$2,196	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
EBMS [11003]	Aetna PPO	$2,447	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS [11003]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS [11003]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
EBMS [11003]	Aetna PPO	$7,511	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$318	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
EBMS [12241]	Multiplan	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan PPO	$1,384	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan PPO	$2,484	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan PPO	$2,768	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
EBMS [12241]	Multiplan PPO	$8,495	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
FIRST CHOICE [13399]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
FIRST HEALTH [12210]	First Health PPO	$1,398	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
FIRST HEALTH [12210]	First Health PPO	$2,510	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
FIRST HEALTH [12210]	First Health PPO	$2,797	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
FIRST HEALTH [12210]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
FIRST HEALTH [12210]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
FIRST HEALTH [12210]	First Health PPO	$8,584	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HCC MEDICAL [12274]	First Health PPO	$1,398	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
HCC MEDICAL [12274]	First Health PPO	$2,510	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
HCC MEDICAL [12274]	First Health PPO	$2,797	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HCC MEDICAL [12274]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
HCC MEDICAL [12274]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HCC MEDICAL [12274]	First Health PPO	$8,584	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$318	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$1,384	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$2,484	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$2,768	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$8,495	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
HEALTH ALLIANCE [13233]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$318	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
HUMANA [12224]	Multiplan	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan PPO	$1,384	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan PPO	$2,484	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan PPO	$2,768	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HUMANA [12224]	Multiplan PPO	$8,495	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ILWU-PMA [13158]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ILWU-PMA [13158]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser Exchange	$801	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser Exchange	$1,438	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser Exchange	$1,602	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser Exchange	$2,459	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser Exchange	$2,459	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser Exchange	$4,918	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser HMO	$947	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser HMO	$1,699	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser HMO	$1,894	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser HMO	$2,906	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser HMO	$2,906	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser HMO	$5,812	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser PPO	$1,093	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser PPO	$1,961	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser PPO	$2,185	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser PPO	$3,353	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser PPO	$3,353	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser PPO	$6,707	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser HMO	$947	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser HMO	$1,699	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser HMO	$1,894	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser HMO	$2,906	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser HMO	$2,906	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser HMO	$5,812	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$318	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$1,384	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$2,484	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$2,768	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$8,495	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KPS [13109]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
KPS [13109]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
KPS [13109]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KPS [13109]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KPS [13109]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
KPS [13109]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
LEWERMARK [12286]	First Health PPO	$1,398	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
LEWERMARK [12286]	First Health PPO	$2,510	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
LEWERMARK [12286]	First Health PPO	$2,797	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
LEWERMARK [12286]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
LEWERMARK [12286]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
LEWERMARK [12286]	First Health PPO	$8,584	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$318	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$1,384	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$2,484	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$2,768	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$8,495	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDISHARE [12287]	First Health PPO	$1,398	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MEDISHARE [12287]	First Health PPO	$2,510	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
MEDISHARE [12287]	First Health PPO	$2,797	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDISHARE [12287]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDISHARE [12287]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
MEDISHARE [12287]	First Health PPO	$8,584	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEGA LIFE [13111]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MEGA LIFE [13111]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
MEGA LIFE [13111]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEGA LIFE [13111]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
MEGA LIFE [13111]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEGA LIFE [13111]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
MERITAIN HEALTH [13229]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Aetna	$144	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MERITAIN [12251]	Aetna	$216	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
MERITAIN [12251]	Aetna PPO	$1,224	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Aetna PPO	$2,196	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Aetna PPO	$2,447	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Aetna PPO	$7,511	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$318	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
MERITAIN [12251]	Multiplan	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan PPO	$1,384	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan PPO	$2,484	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan PPO	$2,768	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
MERITAIN [12251]	Multiplan PPO	$8,495	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
MODA FC [13219]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA FC [13219]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna PPO	$1,224	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna PPO	$2,196	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna PPO	$2,447	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna PPO	$7,511	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$318	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
MODA [12842]	Multiplan	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan PPO	$1,384	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan PPO	$2,484	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan PPO	$2,768	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
MODA [12842]	Multiplan PPO	$8,495	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$1,093	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$1,961	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$2,185	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$3,353	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$3,353	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$6,707	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$113	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$169	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$199	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$318	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$1,384	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$2,484	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$2,768	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$8,495	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$1,398	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$2,510	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$2,797	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$8,584	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$318	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
PEHP [12235]	Multiplan	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan PPO	$1,384	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan PPO	$2,484	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan PPO	$2,768	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PEHP [12235]	Multiplan PPO	$8,495	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$1,311	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$2,353	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$2,622	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$4,024	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$4,024	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$8,048	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PERSONIFY FC [13155]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$157	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$236	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PERSONIFY [12270]	Cigna	$133	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PERSONIFY [12270]	Cigna PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREFERRED ONE [11008]	Aetna	$144	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna	$216	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PREFERRED ONE [11008]	Aetna PPO	$1,224	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$2,196	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$2,447	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$7,511	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$318	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$1,384	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$2,484	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$2,768	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$8,495	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera BC Heritage Prime	$142	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera BC Heritage Prime	$213	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PREMERA [11600]	Premera BC Heritage Signature/Lifewise	$142	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera BC Heritage Signature/Lifewise	$213	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PREMERA [11600]	Premera Exchange	$787	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Exchange	$1,412	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Exchange	$1,573	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Exchange	$2,414	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Exchange	$2,414	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Exchange	$4,829	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera HMO	$991	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera HMO	$1,778	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera HMO	$1,981	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera HMO	$3,040	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera HMO	$3,040	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera HMO	$6,081	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Narrow Network	$1,063	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Narrow Network	$1,909	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Narrow Network	$2,127	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Narrow Network	$3,264	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Narrow Network	$3,264	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Narrow Network	$6,528	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera PPO	$1,209	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera PPO	$2,170	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera PPO	$2,418	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera PPO	$3,711	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera PPO	$3,711	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera PPO	$7,422	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Public Option	$787	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Public Option	$1,412	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Public Option	$1,573	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Public Option	$2,414	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Public Option	$2,414	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PREMERA [11600]	Premera Public Option	$4,829	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PSEW [13124]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
PSEW [13124]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
PSEW [13124]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PSEW [13124]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PSEW [13124]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
PSEW [13124]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE UMP [12263]	Regence UMP	$130	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$195	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
REGENCE UMP [12263]	Regence UMP	$947	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
REGENCE UMP [12263]	Regence UMP	$1,699	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
REGENCE UMP [12263]	Regence UMP	$1,894	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE UMP [12263]	Regence UMP	$2,906	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
REGENCE UMP [12263]	Regence UMP	$2,906	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE UMP [12263]	Regence UMP	$5,812	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence Exchange	$787	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence Exchange	$1,412	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence Exchange	$1,573	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence Exchange	$2,414	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence Exchange	$2,414	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence Exchange	$4,829	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence PPO	$1,209	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence PPO	$2,170	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence PPO	$2,418	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence PPO	$3,711	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence PPO	$3,711	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11903]	Regence PPO	$7,422	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11909]	Regence Exchange	$787	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
REGENCE [11909]	Regence Exchange	$1,412	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
REGENCE [11909]	Regence Exchange	$1,573	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11909]	Regence Exchange	$2,414	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REGENCE [11909]	Regence Exchange	$2,414	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
REGENCE [11909]	Regence Exchange	$4,829	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
REHN & ASSOCIATES [13182]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$1,398	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$2,510	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$2,797	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$4,292	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$8,584	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
SAMARITAN HEALTH [12265]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
SELECT HEALTH [12277]	Multiplan	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$318	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient	—
SELECT HEALTH [12277]	Multiplan	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$1,384	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$2,484	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$2,768	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$4,248	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$8,495	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
STARMARK [13103]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
STARMARK [13103]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
TRUSTEED PLANS [13186]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UMR [12246]	United Exchange	$167	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UMR [12246]	United Exchange	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UMR [12246]	United Exchange	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Exchange	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Exchange	$251	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
UMR [12246]	United Exchange	$199	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$167	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UMR [12246]	United Healthcare	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$251	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
UMR [12246]	United Healthcare	$199	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Narrow Network	$1,093	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UMR [12246]	United Narrow Network	$1,961	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
UMR [12246]	United Narrow Network	$2,185	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UMR [12246]	United Narrow Network	$3,353	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UMR [12246]	United Narrow Network	$3,353	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
UMR [12246]	United Narrow Network	$6,707	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UMR [12246]	United PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UMR [12246]	United PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
UMR [12246]	United PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UMR [12246]	United PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UMR [12246]	United PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
UMR [12246]	United PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$167	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$251	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$199	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$1,093	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$1,961	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$2,185	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$3,353	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$3,353	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$6,707	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$161	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$241	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
UNITED HEALTHCARE [12201]	United HMO	$199	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$1,093	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$1,961	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$2,185	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$3,353	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$3,353	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$6,707	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$1,093	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$1,961	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$2,185	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$3,353	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$3,353	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$6,707	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WEB TPA [11007]	Aetna	$144	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WEB TPA [11007]	Aetna	$216	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
WEB TPA [11007]	Aetna PPO	$1,224	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
WEB TPA [11007]	Aetna PPO	$2,196	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
WEB TPA [11007]	Aetna PPO	$2,447	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WEB TPA [11007]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WEB TPA [11007]	Aetna PPO	$3,756	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
WEB TPA [11007]	Aetna PPO	$7,511	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
WELFARE PENSION [13120]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
WSHIP [13121]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
WSHIP [13121]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$147	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$212	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$221	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$212	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ZENITH [13123]	First Choice PPO	$1,238	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ZENITH [13123]	First Choice PPO	$2,222	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
ZENITH [13123]	First Choice PPO	$2,476	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ZENITH [13123]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
ZENITH [13123]	First Choice PPO	$3,801	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ZENITH [13123]	First Choice PPO	$7,601	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—

Medicaid managed care 126 prices

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

Medicaid managed care prices for Leg or foot MRI without contrast (not a joint) at Seattle Children's Hospital
Payer	Plan	Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
CHPW [15802]	CHPW Apple Health	$37.73	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$56.59	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
CHPW [15802]	CHPW Apple Health	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHPW [15802]	CHPW Apple Health	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$133	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$378	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CHPW [15802]	CHPW Apple Health	$679	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
CHPW [15802]	CHPW Apple Health	$756	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHPW [15802]	CHPW Apple Health	$1,161	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
CHPW [15802]	CHPW Apple Health	$1,161	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHPW [15802]	CHPW Apple Health	$2,321	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$38.46	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$57.69	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$125	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$385	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$692	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$771	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$1,183	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$1,183	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$2,366	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$385	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$692	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$771	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$1,183	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$1,183	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$2,366	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$40.29	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$60.44	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ICW UHC [15812]	United Community Apple Health	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$133	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$385	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$692	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$771	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$1,183	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$1,183	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ICW UHC [15812]	United Community Apple Health	$2,366	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$38.46	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$57.69	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$125	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$385	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$692	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$771	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$1,183	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$1,183	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$2,366	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$38.46	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$57.69	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
KAISER [15818]	Molina Apple Health	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$125	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$374	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$672	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$749	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$1,149	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$1,149	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
KAISER [15818]	Molina Apple Health	$2,298	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$38.46	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$57.69	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
MOLINA [15809]	Molina Apple Health	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$125	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$374	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$672	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$749	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$1,149	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$1,149	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
MOLINA [15809]	Molina Apple Health	$2,298	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$385	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$692	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$771	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$1,183	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$1,183	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$2,366	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$474	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$850	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$947	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$1,454	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$1,454	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$2,907	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$40.29	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$60.44	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$133	Doctor’s fee	MRI 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	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$133	Doctor’s fee	MRI 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	$133	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$474	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$850	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$947	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$1,454	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$1,454	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$2,907	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$40.29	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$60.44	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$133	Doctor’s fee	MRI 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	$133	Doctor’s fee	MRI 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	$133	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$385	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$692	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$771	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$1,183	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$1,183	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$2,366	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$38.46	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$57.69	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$125	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$385	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$692	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$771	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$1,183	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$1,183	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$2,366	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—

Medicaid (state program) 12 prices

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

Medicaid (state program) prices for Leg or foot MRI without contrast (not a joint) at Seattle Children's Hospital
Payer	Plan	Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
MEDICAID WA [14900]	Washington Medicaid	$36.63	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$54.95	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
MEDICAID WA [14900]	Washington Medicaid	$119	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$119	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$119	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$119	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$367	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$659	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$734	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$1,127	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$1,127	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$2,253	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—

Other government program 12 prices

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

Other government program prices for Leg or foot MRI without contrast (not a joint) at Seattle Children's Hospital
Payer	Plan	Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
USFHP [12208]	Pac Med	$76.52	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$115	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
USFHP [12208]	Pac Med	$186	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
USFHP [12208]	Pac Med	$186	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$186	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$186	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$597	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
USFHP [12208]	Pac Med	$1,072	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
USFHP [12208]	Pac Med	$1,194	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
USFHP [12208]	Pac Med	$1,833	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
USFHP [12208]	Pac Med	$1,833	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
USFHP [12208]	Pac Med	$3,666	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—

Unknown 120 prices

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

Unknown prices for Leg or foot MRI without contrast (not a joint) at Seattle Children's Hospital
Payer	Plan	Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
AETNA [11000]	Aetna	$144	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
AETNA [11000]	Aetna	$216	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ASURIS [11900]	Regence Blue Shield	$137	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASURIS [11900]	Regence Blue Shield	$206	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
ASURIS [11913]	Regence Blue Shield	$137	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASURIS [11913]	Regence Blue Shield	$206	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$36.63	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$54.95	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$119	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$119	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$119	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$119	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$367	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$659	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$734	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$1,127	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$1,127	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$2,253	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
CIGNA [12204]	Cigna	$157	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$236	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
CIGNA [12204]	Cigna	$133	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$1,311	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$2,353	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$2,622	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$4,024	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$4,024	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$8,048	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$42.12	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$63.19	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$137	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$137	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$137	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$137	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$36.63	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$54.95	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
HOSPICE [17306]	Washington Medicaid	$119	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HOSPICE [17306]	Washington Medicaid	$119	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$119	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$119	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$367	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
HOSPICE [17306]	Washington Medicaid	$659	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
HOSPICE [17306]	Washington Medicaid	$734	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HOSPICE [17306]	Washington Medicaid	$1,127	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
HOSPICE [17306]	Washington Medicaid	$1,127	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
HOSPICE [17306]	Washington Medicaid	$2,253	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser	$152	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$186	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$186	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13400]	Kaiser	$186	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$229	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
KAISER [13400]	Kaiser	$186	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$152	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$186	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$186	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$186	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
KAISER [13401]	Kaiser	$229	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
KAISER [13401]	Kaiser	$186	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$36.63	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$54.95	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$119	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$119	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$119	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$119	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$367	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$659	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$734	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$1,127	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$1,127	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$2,253	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
MODA [11009]	Aetna	$144	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MODA [11009]	Aetna	$216	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
OPTICARE [15895]	Coordinated Care Vision	$38.46	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$57.69	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
OPTICARE [15895]	Coordinated Care Vision	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$125	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$125	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PB CIGNA CRD [12283]	Cigna	$157	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$236	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PB CIGNA CRD [12283]	Cigna	$133	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
PB PREMERA [11601]	Premera Blue Cross	$142	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PB PREMERA [11601]	Premera Blue Cross	$213	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PB REGENCE [11908]	Regence Blue Shield	$137	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PB REGENCE [11908]	Regence Blue Shield	$206	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PREMERA [11600]	Premera Blue Cross	$142	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera Blue Cross	$213	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$157	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$236	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$133	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Blue Shield	$137	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REGENCE [11903]	Regence Blue Shield	$206	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
REGENCE [11909]	Regence Blue Shield	$137	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REGENCE [11909]	Regence Blue Shield	$206	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$133	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$157	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$236	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$133	Hospital’s fee	MRI Lower Extremity W/O Dye	percent of total billed charges	Inpatient or outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$1,282	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only	percent of total billed charges	Outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$2,301	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd	percent of total billed charges	Outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$2,564	Hospital’s fee	MRI Lower Ext W/O Contrast - for Whole Body Use Only\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$3,935	Hospital’s fee	MRI Lower Ext W/O Contrast - Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$3,935	Hospital’s fee	MRI Lower Ext W/O Contrast	percent of total billed charges	Outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$7,869	Hospital’s fee	MRI Lower Ext W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$167	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	percent of total billed charges	Outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$199	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$251	Doctor’s fee	MRI Lower Extremity W/O Dye\|PROFESSIONAL COMPONENT\|BILATERAL PROCEDURE	fee schedule	Inpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$199	Hospital’s fee	MRI 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 9 prices

List price (before discounts) 12 prices

Commercial insurance 892 prices

Medicaid managed care 126 prices

Medicaid (state program) 12 prices

Other government program 12 prices

Unknown 120 prices

Doctors here who do this procedure

Hospital's feeSent by the hospital

RadiologistSent by the radiology group