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MILLE LACS HEALTH SYSTEM · MRI BRAIN STEM W/O DYE
$206.50
Source file dated 2026-08-13 · both
Source note: IP/OP DISCOUNT BASED ON SELF PAY CONTRACT(S). PAYOR NEGOTIATED RATE BASED ON IP ALL. MAXIMUM QUANTITY OF 0 PER CPT BY DAY. MIN/MAX BASED ON SAME BILLABLE CODE.
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