Seattle Children's Hospital

SeattleKing CountyChildrens

Leg blood vessel MRI (MRA)

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

What you may pay

With insurance from an employer or private plan: $142 – $13,922At least one plan lists 8 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): $353 – $14,502The hospital lists 8 separate amounts for this procedure. They may be parts of one bill that you pay together (for example the hospital’s fee and the fee of the doctor who reads a scan) or alternatives (inpatient or outpatient). We don’t show one price or compare it until we can tell which; every line is listed below. Ask the hospital which lines apply to you.

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

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

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

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

Bills to expect

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

Separate bills for this procedure and their estimated amounts
Bill	Who sends it	How likely	Status	Traditional Medicare allows	Private plans (estimate)
Hospital's feeThe scan: equipment, technologist and contrast dye if used	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	$90	$106 to $161
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 $58 to $69 of about $289 to $344 billed to your plan.

Your share of the hospital's bill is about $37; 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.
$183
Your plan pays
$147
Your coinsurance
$36.69
You oweThe provider bills you this after the insurer pays.
$36.69
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.
$106
Your plan pays
$84.65
Your coinsurance
$21.16
You oweThe provider bills you this after the insurer pays.
$21.16

All bills: allowed amounts: $289
Your plan pays: $231
You owe in all: $57.85

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 blood vessel mri (mra) at Seattle Children's Hospital

Hello,

I am planning a leg blood vessel mri (mra) (billing code CPT 73725) 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 blood vessel mri (mra)."

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).

1,259 published prices, grouped by who each price applies to.

Cash price 11 prices

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

Cash price prices for Leg blood vessel MRI (MRA) at Seattle Children's Hospital
Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
$353	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	—	Inpatient or outpatient	—
$353	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	—	Inpatient or outpatient	—
$353	Hospital’s fee	MR Angio Lower Extrem (Mra)	—	Inpatient or outpatient	—
$2,381	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	—	Inpatient or outpatient	—
$4,761	Hospital’s fee	MR Angio Ext Lower W/O Contrast	—	Inpatient or outpatient	—
$4,761	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	—	Inpatient or outpatient	—
$5,029	Hospital’s fee	MR Angio Ext Lower W/O Contrast	—	Inpatient or outpatient	—
$7,251	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	—	Inpatient or outpatient	—
$9,521	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	—	Inpatient or outpatient	—
$10,057	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	—	Inpatient or outpatient	—
$14,502	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	—	Inpatient or 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 blood vessel MRI (MRA) at Seattle Children's Hospital
Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
$353	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	—	Inpatient or outpatient	—
$353	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	—	Inpatient or outpatient	—
$353	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	—	Inpatient or outpatient	—
$353	Hospital’s fee	MR Angio Lower Extrem (Mra)	—	Inpatient or outpatient	—
$2,381	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	—	Inpatient or outpatient	—
$4,761	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	—	Inpatient or outpatient	—
$4,761	Hospital’s fee	MR Angio Ext Lower W/O Contrast	—	Inpatient or outpatient	—
$5,029	Hospital’s fee	MR Angio Ext Lower W/O Contrast	—	Inpatient or outpatient	—
$7,251	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	—	Inpatient or outpatient	—
$9,521	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	—	Inpatient or outpatient	—
$10,057	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	—	Inpatient or outpatient	—
$14,502	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	—	Inpatient or outpatient	—

Commercial insurance 983 prices

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

Commercial insurance prices for Leg blood vessel MRI (MRA) 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	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$1,904	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$3,809	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$3,809	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$4,023	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$5,801	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$7,617	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$8,045	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice EHN	$11,602	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$1,785	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$3,571	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$3,571	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$3,771	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$5,438	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$7,141	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$7,542	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice PSHVN	$10,877	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ADMINISTRATORS [13102]	First Choice Puget Sound High Value	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
AETNA [11000]	Aetna PPO	$2,000	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
AETNA [11000]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
AETNA [11000]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
AETNA [11000]	Aetna PPO	$4,224	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
AETNA [11000]	Aetna PPO	$6,091	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
AETNA [11000]	Aetna PPO	$7,997	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
AETNA [11000]	Aetna PPO	$8,448	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
AETNA [11000]	Aetna PPO	$12,182	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$209	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna	$177	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ALLEGIANCE [12264]	Cigna PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ALLIED [13129]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$2,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$4,827	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$6,961	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$9,140	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$9,654	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ALTIUS HEALTH PLAN [12275]	First Health PPO	$13,922	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna	$192	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna PPO	$2,000	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna PPO	$4,224	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna PPO	$6,091	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna PPO	$7,997	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna PPO	$8,448	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
AMERIBEN [11006]	Aetna PPO	$12,182	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ASSURANT HEALTH FC [13135]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11900]	Regence PPO	$1,976	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11900]	Regence PPO	$3,951	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11900]	Regence PPO	$3,951	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11900]	Regence PPO	$4,174	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11900]	Regence PPO	$6,019	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11900]	Regence PPO	$7,902	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11900]	Regence PPO	$8,347	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11900]	Regence PPO	$12,037	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11913]	Regence Exchange	$1,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11913]	Regence Exchange	$2,571	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11913]	Regence Exchange	$2,571	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11913]	Regence Exchange	$2,715	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11913]	Regence Exchange	$3,916	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11913]	Regence Exchange	$5,141	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11913]	Regence Exchange	$5,431	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ASURIS [11913]	Regence Exchange	$7,831	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$1,976	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$3,951	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$3,951	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$4,174	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$6,019	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$7,902	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$8,347	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
BLUECROSS/SHIELD [11902]	Regence PPO	$12,037	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Blue Shield	$183	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$1,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$2,571	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$2,571	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$2,715	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$3,916	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$5,141	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$5,431	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
BRIDGESPAN HEALTH COMPANY [11906]	Regence Exchange	$7,831	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CARPENTERS TRUST [13100]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$142	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Cascade Care	$177	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$1,309	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$2,618	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$2,618	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$2,766	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$3,988	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$5,236	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$5,531	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CHPW CASCADE [12228]	CHPW Public Option	$7,976	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna	$192	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$2,000	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$4,224	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$6,091	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$7,997	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$8,448	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CHRISTIAN BROTHERS [11001]	Aetna PPO	$12,182	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna Narrow Network	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna Narrow Network	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna Narrow Network	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna Narrow Network	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna Narrow Network	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna Narrow Network	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna Narrow Network	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna Narrow Network	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan PPO	$2,261	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan PPO	$4,777	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan PPO	$6,889	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan PPO	$9,045	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan PPO	$9,554	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CLARITEV [12299]	Multiplan PPO	$13,777	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMINISTRATIVE [13140]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$143	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$265	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$265	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Ambetter	$265	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$1,785	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$3,571	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$3,571	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$3,771	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$5,438	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$7,141	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$7,542	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Exchange	$10,877	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$143	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$265	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$265	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$265	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$1,309	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$2,618	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$2,618	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$2,766	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$3,988	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$5,236	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$5,531	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [12267]	Coordinated Care Public Option	$7,976	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna	$192	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna PPO	$2,000	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna PPO	$4,224	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna PPO	$6,091	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna PPO	$7,997	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna PPO	$8,448	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CORESOURCE [11004]	Aetna PPO	$12,182	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COVENTRY FC [13112]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
COVENTRY FC [13112]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COVENTRY FC [13112]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COVENTRY FC [13112]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COVENTRY FC [13112]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COVENTRY FC [13112]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COVENTRY FC [13112]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COVENTRY FC [13112]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$2,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$4,827	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$6,961	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$9,140	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$9,654	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COVENTRY MHBP [12272]	First Health PPO	$13,922	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COVENTRY [12244]	First Health PPO	$2,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
COVENTRY [12244]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COVENTRY [12244]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COVENTRY [12244]	First Health PPO	$4,827	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COVENTRY [12244]	First Health PPO	$6,961	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COVENTRY [12244]	First Health PPO	$9,140	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COVENTRY [12244]	First Health PPO	$9,654	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COVENTRY [12244]	First Health PPO	$13,922	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EBMS FC [13144]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EBMS [11003]	Aetna	$192	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EBMS [11003]	Aetna PPO	$2,000	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
EBMS [11003]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EBMS [11003]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
EBMS [11003]	Aetna PPO	$4,224	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
EBMS [11003]	Aetna PPO	$6,091	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
EBMS [11003]	Aetna PPO	$7,997	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EBMS [11003]	Aetna PPO	$8,448	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EBMS [11003]	Aetna PPO	$12,182	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan PPO	$2,261	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan PPO	$4,777	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan PPO	$6,889	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan PPO	$9,045	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan PPO	$9,554	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EBMS [12241]	Multiplan PPO	$13,777	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
FIRST CHOICE [13399]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
FIRST HEALTH [12210]	First Health PPO	$2,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
FIRST HEALTH [12210]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
FIRST HEALTH [12210]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
FIRST HEALTH [12210]	First Health PPO	$4,827	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
FIRST HEALTH [12210]	First Health PPO	$6,961	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
FIRST HEALTH [12210]	First Health PPO	$9,140	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
FIRST HEALTH [12210]	First Health PPO	$9,654	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
FIRST HEALTH [12210]	First Health PPO	$13,922	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
GUARDIAN FC [13105]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HCC MEDICAL [12274]	First Health PPO	$2,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
HCC MEDICAL [12274]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
HCC MEDICAL [12274]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HCC MEDICAL [12274]	First Health PPO	$4,827	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
HCC MEDICAL [12274]	First Health PPO	$6,961	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
HCC MEDICAL [12274]	First Health PPO	$9,140	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HCC MEDICAL [12274]	First Health PPO	$9,654	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HCC MEDICAL [12274]	First Health PPO	$13,922	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$2,261	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$4,777	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$6,889	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$9,045	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$9,554	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [12266]	Multiplan PPO	$13,777	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HEALTH ALLIANCE [13233]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan PPO	$2,261	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan PPO	$4,777	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan PPO	$6,889	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan PPO	$9,045	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan PPO	$9,554	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HUMANA [12224]	Multiplan PPO	$13,777	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ILWU-PMA [13158]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser Exchange	$1,309	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser Exchange	$2,618	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser Exchange	$2,618	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser Exchange	$2,766	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser Exchange	$3,988	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser Exchange	$5,236	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser Exchange	$5,531	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser Exchange	$7,976	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser HMO	$1,547	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser HMO	$3,095	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser HMO	$3,095	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser HMO	$3,269	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser HMO	$4,713	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser HMO	$6,188	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser HMO	$6,537	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser HMO	$9,427	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser PPO	$1,785	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser PPO	$3,571	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser PPO	$3,571	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser PPO	$3,771	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser PPO	$5,438	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser PPO	$7,141	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser PPO	$7,542	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser PPO	$10,877	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser HMO	$1,547	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser HMO	$3,095	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser HMO	$3,095	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser HMO	$3,269	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser HMO	$4,713	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser HMO	$6,188	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser HMO	$6,537	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser HMO	$9,427	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$2,261	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$4,777	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$6,889	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$9,045	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$9,554	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KEY BENEFIT ADMIN [12276]	Multiplan PPO	$13,777	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KPS [13109]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
KPS [13109]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KPS [13109]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KPS [13109]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KPS [13109]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KPS [13109]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KPS [13109]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KPS [13109]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
LEWERMARK [12286]	First Health PPO	$2,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
LEWERMARK [12286]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
LEWERMARK [12286]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
LEWERMARK [12286]	First Health PPO	$4,827	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
LEWERMARK [12286]	First Health PPO	$6,961	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
LEWERMARK [12286]	First Health PPO	$9,140	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
LEWERMARK [12286]	First Health PPO	$9,654	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
LEWERMARK [12286]	First Health PPO	$13,922	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
LOOMIS BENEFITS WEST [13161]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$2,261	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$4,777	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$6,889	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$9,045	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$9,554	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEDICAL MUTUAL [12233]	Multiplan PPO	$13,777	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEDISHARE [12287]	First Health PPO	$2,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
MEDISHARE [12287]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEDISHARE [12287]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MEDISHARE [12287]	First Health PPO	$4,827	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MEDISHARE [12287]	First Health PPO	$6,961	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MEDISHARE [12287]	First Health PPO	$9,140	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEDISHARE [12287]	First Health PPO	$9,654	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEDISHARE [12287]	First Health PPO	$13,922	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEGA LIFE [13111]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
MEGA LIFE [13111]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEGA LIFE [13111]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MEGA LIFE [13111]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MEGA LIFE [13111]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MEGA LIFE [13111]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEGA LIFE [13111]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEGA LIFE [13111]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN HEALTH [13229]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Aetna	$192	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MERITAIN [12251]	Aetna PPO	$2,000	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Aetna PPO	$4,224	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Aetna PPO	$6,091	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Aetna PPO	$7,997	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Aetna PPO	$8,448	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Aetna PPO	$12,182	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan PPO	$2,261	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan PPO	$4,777	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan PPO	$6,889	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan PPO	$9,045	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan PPO	$9,554	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MERITAIN [12251]	Multiplan PPO	$13,777	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA FC [13219]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA [11009]	Aetna PPO	$2,000	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
MODA [11009]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MODA [11009]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA [11009]	Aetna PPO	$4,224	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MODA [11009]	Aetna PPO	$6,091	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MODA [11009]	Aetna PPO	$7,997	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA [11009]	Aetna PPO	$8,448	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA [11009]	Aetna PPO	$12,182	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan PPO	$2,261	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan PPO	$4,777	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan PPO	$6,889	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan PPO	$9,045	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan PPO	$9,554	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA [12842]	Multiplan PPO	$13,777	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$1,785	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$3,571	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$3,571	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$3,771	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$5,438	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$7,141	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$7,542	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Exchange	$10,877	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$150	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$265	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$265	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA MARKETPLACE [12831]	Molina Marketplace Exchange	$265	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MYERS STEVENS & TOOHEY [13169]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$2,261	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$4,777	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$6,889	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$9,045	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$9,554	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
NIPPON LIFE INSURANCE [12232]	Multiplan PPO	$13,777	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PACIFIC UNDERWRITERS [13175]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$2,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$4,827	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$6,961	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$9,140	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$9,654	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PACIFICSOURCE [12245]	First Health PPO	$13,922	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan PPO	$2,261	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan PPO	$4,777	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan PPO	$6,889	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan PPO	$9,045	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan PPO	$9,554	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PEHP [12235]	Multiplan PPO	$13,777	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$2,142	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$4,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$4,285	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$4,526	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$6,526	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$8,569	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$9,051	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY CONTRACTED [12205]	6 Degrees Health	$13,052	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY FC [13155]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$209	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna	$177	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PERSONIFY [12270]	Cigna PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna	$192	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$2,000	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$4,224	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$6,091	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$7,997	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$8,448	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREFERRED ONE [11008]	Aetna PPO	$12,182	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$2,261	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$4,777	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$6,889	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$9,045	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$9,554	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREFERREDONE ADMIN SERVICES [12236]	Multiplan PPO	$13,777	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera BC Heritage Prime	$189	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera BC Heritage Signature/Lifewise	$189	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera Exchange	$1,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Exchange	$2,571	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Exchange	$2,571	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Exchange	$2,715	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Exchange	$3,916	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Exchange	$5,141	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Exchange	$5,431	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Exchange	$7,831	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera HMO	$1,619	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera HMO	$3,237	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera HMO	$3,237	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera HMO	$3,419	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera HMO	$4,931	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera HMO	$6,474	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera HMO	$6,838	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera HMO	$9,862	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Narrow Network	$1,738	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Narrow Network	$3,475	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Narrow Network	$3,475	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Narrow Network	$3,671	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Narrow Network	$5,293	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Narrow Network	$6,950	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Narrow Network	$7,341	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Narrow Network	$10,587	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera PPO	$1,976	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera PPO	$3,951	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera PPO	$3,951	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera PPO	$4,174	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera PPO	$6,019	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera PPO	$7,902	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera PPO	$8,347	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera PPO	$12,037	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Public Option	$1,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Public Option	$2,571	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Public Option	$2,571	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Public Option	$2,715	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Public Option	$3,916	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Public Option	$5,141	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Public Option	$5,431	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PREMERA [11600]	Premera Public Option	$7,831	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PRINCIPAL MUTUAL FC [13115]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [13181]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PSEW [13124]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
PSEW [13124]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PSEW [13124]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PSEW [13124]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PSEW [13124]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
PSEW [13124]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PSEW [13124]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
PSEW [13124]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$174	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$1,547	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$3,095	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$3,095	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$3,269	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$4,713	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$6,188	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$6,537	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE UMP [12263]	Regence UMP	$9,427	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Exchange	$1,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Exchange	$2,571	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Exchange	$2,571	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Exchange	$2,715	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Exchange	$3,916	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Exchange	$5,141	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Exchange	$5,431	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Exchange	$7,831	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence PPO	$1,976	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence PPO	$3,951	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence PPO	$3,951	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence PPO	$4,174	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence PPO	$6,019	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence PPO	$7,902	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence PPO	$8,347	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence PPO	$12,037	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11909]	Regence Exchange	$1,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11909]	Regence Exchange	$2,571	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11909]	Regence Exchange	$2,571	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11909]	Regence Exchange	$2,715	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11909]	Regence Exchange	$3,916	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11909]	Regence Exchange	$5,141	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11909]	Regence Exchange	$5,431	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11909]	Regence Exchange	$7,831	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
REHN & ASSOCIATES [13182]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$2,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$4,570	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$4,827	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$6,961	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$9,140	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$9,654	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
RURAL CARRIER BENEFIT PLAN [12271]	First Health PPO	$13,922	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
SAMARITAN HEALTH [12265]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$2,261	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$4,523	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$4,777	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$6,889	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$9,045	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$9,554	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
SELECT HEALTH [12277]	Multiplan PPO	$13,777	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
SOUND HEALTH AND WELLNESS [13116]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
STARMARK [13103]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TONGASS TIMBER TRUST [13202]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TRUSTEED PLANS [13186]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TRUSTMARK LIFE INSURANCE [13203]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Exchange	$223	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UMR [12246]	United Exchange	$265	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Exchange	$265	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Exchange	$265	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$223	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$265	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$265	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Healthcare	$265	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Narrow Network	$1,785	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Narrow Network	$3,571	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Narrow Network	$3,571	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Narrow Network	$3,771	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Narrow Network	$5,438	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Narrow Network	$7,141	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Narrow Network	$7,542	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United Narrow Network	$10,877	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UMR [12246]	United PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$223	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$265	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$265	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$265	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$1,785	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$3,571	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$3,571	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$3,771	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$5,438	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$7,141	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$7,542	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Exchange	$10,877	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$214	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$265	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$265	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$265	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$1,785	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$3,571	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$3,571	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$3,771	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$5,438	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$7,141	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$7,542	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United HMO	$10,877	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$1,785	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$3,571	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$3,571	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$3,771	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$5,438	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$7,141	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$7,542	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Narrow Network	$10,877	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WEB TPA [11007]	Aetna	$192	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WEB TPA [11007]	Aetna PPO	$2,000	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
WEB TPA [11007]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
WEB TPA [11007]	Aetna PPO	$3,999	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WEB TPA [11007]	Aetna PPO	$4,224	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
WEB TPA [11007]	Aetna PPO	$6,091	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
WEB TPA [11007]	Aetna PPO	$7,997	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WEB TPA [11007]	Aetna PPO	$8,448	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WEB TPA [11007]	Aetna PPO	$12,182	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WELFARE PENSION [13120]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WSHIP [13121]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$196	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$282	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice	$282	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ZENITH AMERICAN SOLUTIONS [13195]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ZENITH [13123]	First Choice PPO	$2,023	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
ZENITH [13123]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ZENITH [13123]	First Choice PPO	$4,047	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ZENITH [13123]	First Choice PPO	$4,274	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ZENITH [13123]	First Choice PPO	$6,164	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ZENITH [13123]	First Choice PPO	$8,093	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ZENITH [13123]	First Choice PPO	$8,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ZENITH [13123]	First Choice PPO	$12,327	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—

Medicaid managed care 132 prices

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

Medicaid managed care prices for Leg blood vessel MRI (MRA) 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	$50.24	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$177	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$618	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$1,236	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$1,236	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$1,305	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$1,882	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$2,471	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$2,610	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CHPW [15802]	CHPW Apple Health	$3,764	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$51.22	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$167	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$167	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$167	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$630	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$1,260	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$1,260	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$1,331	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$1,919	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$2,519	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$2,661	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COORDINATED CARE [15815]	Coordinated Care Apple Health	$3,837	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$630	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$1,260	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$1,260	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$1,331	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$1,919	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$2,519	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$2,661	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Apple Health	$3,837	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$53.66	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$177	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$630	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$1,260	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$1,260	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$1,331	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$1,919	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$2,519	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$2,661	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ICW UHC [15812]	United Community Apple Health	$3,837	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$51.22	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$167	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$167	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$167	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$630	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$1,260	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$1,260	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$1,331	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$1,919	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$2,519	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$2,661	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
ICW WELLPOINT [15822]	Amerigroup Apple Health	$3,837	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$51.22	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$167	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$167	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$167	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$612	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$1,224	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$1,224	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$1,293	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$1,864	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$2,447	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$2,585	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [15818]	Molina Apple Health	$3,728	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$51.22	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$167	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$167	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$167	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$612	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$1,224	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$1,224	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$1,293	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$1,864	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$2,447	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$2,585	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MOLINA [15809]	Molina Apple Health	$3,728	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$630	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$1,260	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$1,260	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$1,331	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$1,919	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$2,519	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$2,661	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Apple Health	$3,837	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$774	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$1,548	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$1,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$1,635	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$2,357	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$3,095	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$3,269	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United BH Community Apple Health	$4,714	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$53.66	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UBH COMMUNITY & STATE [15819]	United Community Apple Health	$177	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$774	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$1,548	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$1,548	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$1,635	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$2,357	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$3,095	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$3,269	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United BH Community Apple Health	$4,714	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$53.66	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$177	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$630	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$1,260	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$1,260	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$1,331	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$1,919	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$2,519	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$2,661	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE COMMUNITY PLAN [15816]	United Community Apple Health	$3,837	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$51.22	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$167	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$167	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$167	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$630	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$1,260	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$1,260	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$1,331	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$1,919	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$2,519	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$2,661	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
WELLPOINT [15814]	Amerigroup Apple Health	$3,837	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—

Medicaid (state program) 12 prices

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

Medicaid (state program) prices for Leg blood vessel MRI (MRA) 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	$48.78	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$159	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$159	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$159	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$600	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$1,200	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$1,200	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$1,267	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$1,827	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$2,399	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$2,534	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MEDICAID WA [14900]	Washington Medicaid	$3,655	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—

Other government program 12 prices

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

Other government program prices for Leg blood vessel MRI (MRA) 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	$102	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$247	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$247	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$247	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$976	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$1,952	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$1,952	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$2,062	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$2,973	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$3,903	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$4,123	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
USFHP [12208]	Pac Med	$5,946	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—

Unknown 97 prices

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

Unknown prices for Leg blood vessel MRI (MRA) 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	$192	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASURIS [11900]	Regence Blue Shield	$183	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
ASURIS [11913]	Regence Blue Shield	$183	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$48.78	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$159	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$159	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$159	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$600	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$1,200	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$1,200	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$1,267	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$1,827	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$2,399	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$2,534	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CHILD HEARING LEAGUE [17301]	Washington Medicaid	$3,655	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$209	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
CIGNA [12204]	Cigna	$177	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$2,142	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$4,285	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$4,285	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$4,526	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$6,526	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$8,569	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$9,051	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
COASTAL ADMIN SVCS CONTRACTED [12222]	6 Degrees Health	$13,052	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$56.10	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$183	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$183	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
EYE QUEST [15894]	Amerigroup Eyequest	$183	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$48.78	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$159	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$159	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$159	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$600	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$1,200	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$1,200	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$1,267	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$1,827	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$2,399	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$2,534	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
HOSPICE [17306]	Washington Medicaid	$3,655	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$202	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$247	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$247	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13400]	Kaiser	$247	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$202	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$247	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$247	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
KAISER [13401]	Kaiser	$247	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$48.78	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$159	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$159	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$159	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$600	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$1,200	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$1,200	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$1,267	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$1,827	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$2,399	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$2,534	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MAPLE LANE SCHOOL [17309]	Washington Medicaid	$3,655	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
MODA [11009]	Aetna	$192	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$51.22	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$167	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$167	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
OPTICARE [15895]	Coordinated Care Vision	$167	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$209	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PB CIGNA CRD [12283]	Cigna	$177	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
PB PREMERA [11601]	Premera Blue Cross	$189	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PB REGENCE [11908]	Regence Blue Shield	$183	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PREMERA [11600]	Premera Blue Cross	$189	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$209	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
PROVIDENCE HEALTH PLAN [12289]	Cigna	$177	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
REGENCE [11903]	Regence Blue Shield	$183	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
REGENCE [11909]	Regence Blue Shield	$183	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$177	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$209	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
TUFTS HEALTH PLAN [12279]	Cigna	$177	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$2,095	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd	percent of total billed charges	Inpatient or outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$4,190	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$4,190	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast Ltd\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$4,425	Hospital’s fee	MR Angio Ext Lower W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$6,381	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast	percent of total billed charges	Inpatient or outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$8,378	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$8,850	Hospital’s fee	MR Angio Ext Lower W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED BEHAVIORAL HEALTH [12234]	United Behavioral Health	$12,762	Hospital’s fee	MR Angio Ext Lower W+W/O Contrast\|BILATERAL PROCEDURE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$223	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT	fee schedule	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$265	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|LEFT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$265	Doctor’s fee	MR Angio Lower Extrem (Mra)\|PROFESSIONAL COMPONENT\|RIGHT SIDE	percent of total billed charges	Inpatient or outpatient	—
UNITED HEALTHCARE [12201]	United Healthcare	$265	Hospital’s fee	MR Angio Lower Extrem (Mra)	percent of total billed charges	Inpatient or outpatient	—

Doctors here who do this procedure

We don’t have doctor data for this procedure yet. CMS publishes what doctors bill Traditional Medicare by billing code, and no Washington doctor billed this one often enough for CMS to publish it (11 or more patients a year).

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Seattle Children's Hospital

What you may pay

Bills to expect

What you’d pay for these bills

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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 11 prices

List price (before discounts) 12 prices

Commercial insurance 983 prices

Medicaid managed care 132 prices

Medicaid (state program) 12 prices

Other government program 12 prices

Unknown 97 prices

Doctors here who do this procedure

Hospital's feeSent by the hospital

RadiologistSent by the radiology group