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ST MARYS HOSPITAL MEDICAL CENTER OF GREEN BAY INC HOSPITAL SISTERS · HC CT ABDOMEN/PELVIS W/CONTRAST
$3,016.86
Source file dated 2026-03-24 · both
Source note: 100% of $4,571.00 in Billed Charges for Rev 350 Proc 74177 = $4,571.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
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