[group AETNA-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
AETNA rate: $0
[/group]
[group AETNA-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
AETNA rate: $0
[/group]
[group AETNA-5]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #0
De-Identified (low rate): $100
De-Identified (high rate): $110
AETNA rate: $0
[/group]
[group AETNA-6]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.00
AETNA rate: $771
[/group]
[group AETNA-7]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
AETNA rate: $0
[/group]
[group AETNA-8]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
AETNA rate: $857
[/group]
[group AETNA-9]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
AETNA rate: $0
[/group]
[group AETNA-10]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
AETNA rate: $857
[/group]
[group AETNA-11]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
AETNA rate: $0
[/group]
[group AETNA-10]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
AETNA rate: $857
[/group]
[group AETNA-11]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
AETNA rate: $0
[/group]
[group AETNA-12]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
AETNA rate: $788
[/group]
[group AETNABETTERHEALTHSPRING-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
AETNA BETTER rate: $0
[/group]
[group AETNABETTERHEALTHSPRING-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
AETNA BETTER rate: $0
[/group]
[group AETNABETTERHEALTHSPRING-5]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
AETNA BETTER rate: $0
[/group]
[group AETNABETTERHEALTHSPRING-6]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.00
AETNA BETTER rate: $883
[/group]
[group AETNABETTERHEALTHSPRING-7]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
AETNA BETTER rate: $0
[/group]
[group AETNABETTERHEALTHSPRING-8]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.00
AETNA BETTER rate: $883
[/group]
[group AETNABETTERHEALTHSPRING-9]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
AETNA BETTER rate: $0
[/group]
[group AETNABETTERHEALTHSPRING-10]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160
AETNA BETTER rate: $883
[/group]
[group AETNABETTERHEALTHSPRING-11]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
AETNA BETTER rate: $0
[/group]
[group AETNABETTERHEALTHSPRING-12]
Gross Charge: $2,200.00
Cash Price: $2,200.00
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
AETNA BETTER rate: $883
[/group]
[group ALLSAVERS-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
ALL SAVERS rate: $0
[/group]
[group ALLSAVERS-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
ALL SAVERS rate: $0
[/group]
[group ALLSAVERS-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
ALL SAVERS rate: $0
[/group]
[group ALLSAVERS-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
ALL SAVERS rate: $730
[/group]
[group ALLSAVERS-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $100
ALL SAVERS rate: $0
[/group]
[group ALLSAVERS-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
ALL SAVERS rate: $707
[/group]
[group ALLSAVERS-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
ALL SAVERS rate: $0
[/group]
[group ALLSAVERS-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
ALL SAVERS rate: $707
[/group]
[group ALLSAVERS-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
ALL SAVERS rate: $0
[/group]
[group ALLSAVERS-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
ALL SAVERS rate: $0
[/group]
[group AMBETTERCOMMERCIAL-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
AMBETTER COMMERCIAL rate: $0
[/group]
[group AMBETTERCOMMERCIAL-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
AMBETTER COMMERCIAL rate: $0
[/group]
[group AMBETTERCOMMERCIAL-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
AMBETTER COMMERCIAL rate: $0
[/group]
[group AMBETTERCOMMERCIAL-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
AMBETTER COMMERCIAL rate: $0
[/group]
[group AMBETTERCOMMERCIAL-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
AMBETTER COMMERCIAL rate: $0
[/group]
[group AMBETTERCOMMERCIAL-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
AMBETTER COMMERCIAL rate: $650
[/group]
[group AMBETTERCOMMERCIAL-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
AMBETTER COMMERCIAL rate: $0
[/group]
[group AMBETTERCOMMERCIAL-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
AMBETTER COMMERCIAL rate: $650
[/group]
[group AMBETTERCOMMERCIAL-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
AMBETTER COMMERCIAL rate: $0
[/group]
[group AMBETTERCOMMERCIAL-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
AMBETTER COMMERCIAL rate: $0
[/group]
[group BCBSMEDICARE-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
BCBS MEDICARE rate: $960
[/group]
[group BCBSMEDICARE-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
BCBS MEDICARE rate: $0
[/group]
[group BCBSMEDICARE-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
BCBS MEDICARE rate: $0
[/group]
[group BCBSMEDICARE-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
BCBS MEDICARE rate: $908.10
[/group]
[group BCBSMEDICARE-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
BCBS MEDICARE rate: $0
[/group]
[group BCBSMEDICARE-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
BCBS MEDICARE rate: $908.10
[/group]
[group BCBSMEDICARE-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
BCBS MEDICARE rate: $0
[/group]
[group BCBSMEDICARE-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
BCBS MEDICARE rate: $908.10
[/group]
[group BCBSMEDICARE-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
BCBS MEDICARE rate: $0
[/group]
[group BCBSMEDICARE-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
BCBS MEDICARE rate: $605.40
[/group]
[group BEACONHEALTHSTRATE-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
BEACON HEALTH STRATE rate: $0
[/group]
[group BEACONHEALTHSTRATE-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
BEACON HEALTH STRATE rate: $0
[/group]
[group BEACONHEALTHSTRATE-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
BEACON HEALTH STRATE rate: $0
[/group]
[group BEACONHEALTHSTRATE-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
BEACON HEALTH STRATE rate: $690
[/group]
[group BEACONHEALTHSTRATE-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
BEACON HEALTH STRATE rate: $0
[/group]
[group BEACONHEALTHSTRATE-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
BEACON HEALTH STRATE rate: $769
[/group]
[group BEACONHEALTHSTRATE-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
BEACON HEALTH STRATE rate: $0
[/group]
[group BEACONHEALTHSTRATE-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
BEACON HEALTH STRATE rate: $0
[/group]
[group BEACONHEALTHSTRATE-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
BEACON HEALTH STRATE rate: $0
[/group]
[group BEACONHEALTHSTRATE-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
BEACON HEALTH STRATE rate: $769
[/group]
[group BEACONHLTHOPTIONS-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
BEACON HLTH OPTIONS rate: $0
[/group]
[group BEACONHLTHOPTIONS-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
BEACON HLTH OPTIONS rate: $0
[/group]
[group BEACONHLTHOPTIONS-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
BEACON HLTH OPTIONS rate: $0
[/group]
[group BEACONHLTHOPTIONS-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
BEACON HLTH OPTIONS rate: $690
[/group]
[group BEACONHLTHOPTIONS-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
BEACON HLTH OPTIONS rate: $0
[/group]
[group BEACONHLTHOPTIONS-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
BEACON HLTH OPTIONS rate: $769
[/group]
[group BEACONHLTHOPTIONS-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
BEACON HLTH OPTIONS rate: $0
[/group]
[group BEACONHLTHOPTIONS-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
BEACON HLTH OPTIONS rate: $769
[/group]
[group BEACONHLTHOPTIONS-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
BEACON HLTH OPTIONS rate: $0
[/group]
[group BEACONHLTHOPTIONS-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
BEACON HLTH OPTIONS rate: $769
[/group]
[group BLUECROSS-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
BLUE CROSS rate: $0
[/group]
[group BLUECROSS-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
BLUE CROSS rate: $960
[/group]
[group BLUECROSS-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
BLUE CROSS rate: $0
[/group]
[group BLUECROSS-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
BLUE CROSS rate: $908.10
[/group]
[group BLUECROSS-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
BLUE CROSS rate: $0
[/group]
[group BLUECROSS-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
BLUE CROSS rate: $908.10
[/group]
[group BLUECROSS-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
BLUE CROSS rate: $0
[/group]
[group BLUECROSS-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
BLUE CROSS rate: $908.10
[/group]
[group BLUECROSS-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
BLUE CROSS rate: $0
[/group]
[group BLUECROSS-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
BLUE CROSS rate: $605.40
[/group]
[group BLUECROSSNEWDIREC-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
BLUE CROSS NEW DIREC rate: $0
[/group]
[group BLUECROSSNEWDIREC-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
BLUE CROSS NEW DIREC rate: $960
[/group]
[group BLUECROSSNEWDIREC-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
BLUE CROSS NEW DIREC rate: $0
[/group]
[group BLUECROSSNEWDIREC-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
BLUE CROSS NEW DIREC rate: $908.10
[/group]
[group BLUECROSSNEWDIREC-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
BLUE CROSS NEW DIREC rate: $0
[/group]
[group BLUECROSSNEWDIREC-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
BLUE CROSS NEW DIREC rate: $908.10
[/group]
[group BLUECROSSNEWDIREC-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
BLUE CROSS NEW DIREC rate: $0
[/group]
[group BLUECROSSNEWDIREC-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
BLUE CROSS NEW DIREC rate: $908.10
[/group]
[group BLUECROSSNEWDIREC-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
BLUE CROSS NEW DIREC rate: $0
[/group]
[group BLUECROSSNEWDIREC-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
BLUE CROSS NEW DIREC rate: $605.40
[/group]
[group BRIGHTHEALTH-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
BRIGHT HEALTH rate: $0
[/group]
[group BRIGHTHEALTH-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
BRIGHT HEALTH rate: $0
[/group]
[group BRIGHTHEALTH-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
BRIGHT HEALTH rate: $110
[/group]
[group BRIGHTHEALTH-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
BRIGHT HEALTH rate: $0
[/group]
[group BRIGHTHEALTH-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
BRIGHT HEALTH rate: $110
[/group]
[group BRIGHTHEALTH-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
BRIGHT HEALTH rate: $0
[/group]
[group BRIGHTHEALTH-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
BRIGHT HEALTH rate: $110
[/group]
[group BRIGHTHEALTH-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
BRIGHT HEALTH rate: $0
[/group]
[group BRIGHTHEALTH-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
BRIGHT HEALTH rate: $110
[/group]
[group BRIGHTHEALTH-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
BRIGHT HEALTH rate: $0
[/group]
[group CAREPLUSMAGELLAN-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
CAREPLUS-MAGELLANH rate: $0
[/group]
[group CAREPLUSMAGELLAN-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
CAREPLUS-MAGELLANH rate: $0
[/group]
[group CAREPLUSMAGELLAN-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
CAREPLUS-MAGELLANH rate: $0
[/group]
[group CAREPLUSMAGELLAN-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
CAREPLUS-MAGELLANH rate: $1,699
[/group]
[group CAREPLUSMAGELLAN-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
CAREPLUS-MAGELLANH rate: $0
[/group]
[group CAREPLUSMAGELLAN-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
CAREPLUS-MAGELLANH rate: $1,699
[/group]
[group CAREPLUSMAGELLAN-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
CAREPLUS-MAGELLANH rate: $0
[/group]
[group CAREPLUSMAGELLAN-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
CAREPLUS-MAGELLANH rate: $0
[/group]
[group CAREPLUSMAGELLAN-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
CAREPLUS-MAGELLANH rate: $0
[/group]
[group CAREPLUSMAGELLAN-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
CAREPLUS-MAGELLANH rate: $1,699
[/group]
[group CENPATICO-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
CENPATICO rate: $0
[/group]
[group CENPATICO-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
CENPATICO rate: $0
[/group]
[group CENPATICO-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
CENPATICO rate: $0
[/group]
[group CENPATICO-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
CENPATICO rate: $750
[/group]
[group CENPATICO-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
CENPATICO rate: $0
[/group]
[group CENPATICO-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
CENPATICO rate: $1,468
[/group]
[group CENPATICO-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
CENPATICO rate: $0
[/group]
[group CENPATICO-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
CENPATICO rate: $1,468
[/group]
[group CENPATICO-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
CENPATICO rate: $0
[/group]
[group CENPATICO-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
CENPATICO rate: $718
[/group]
[group CIGNA-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
CIGNA rate: $0
[/group]
[group CIGNA-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
CIGNA rate: $0
[/group]
[group CIGNA-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
CIGNA rate: $0
[/group]
[group CIGNA-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
CIGNA rate: $890
[/group]
[group CIGNA-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
CIGNA rate: $0
[/group]
[group CIGNA-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
CIGNA rate: $890
[/group]
[group CIGNA-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
CIGNA rate: $0
[/group]
[group CIGNA-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
CIGNA rate: $890
[/group]
[group CIGNA-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
CIGNA rate: $0
[/group]
[group CIGNA-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
CIGNA rate: $890
[/group]
[group CIGNAHEALTHSPRING-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
CIGNA HEALTHSPRING rate: $0
[/group]
[group CIGNAHEALTHSPRING-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
CIGNA HEALTHSPRING rate: $0
[/group]
[group CIGNAHEALTHSPRING-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
CIGNA HEALTHSPRING rate: $100
[/group]
[group CIGNAHEALTHSPRING-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
CIGNA HEALTHSPRING rate: $0
[/group]
[group CIGNAHEALTHSPRING-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
CIGNA HEALTHSPRING rate: $100
[/group]
[group CIGNAHEALTHSPRING-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
CIGNA HEALTHSPRING rate: $0
[/group]
[group CIGNAHEALTHSPRING-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
CIGNA HEALTHSPRING rate: $0
[/group]
[group CIGNAHEALTHSPRING-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
CIGNA HEALTHSPRING rate: $0
[/group]
[group CIGNAHEALTHSPRING-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
CIGNA HEALTHSPRING rate: $100
[/group]
[group CIGNAHEALTHSPRING-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
CIGNA HEALTHSPRING rate: $890
[/group]
[group COMPSYCH-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
COMPSYCH rate: $0
[/group]
[group COMPSYCH-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
COMPSYCH rate: $0
[/group]
[group COMPSYCH-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
COMPSYCH rate: $0
[/group]
[group COMPSYCH-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
COMPSYCH rate: $0
[/group]
[group COMPSYCH-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
COMPSYCH rate: $0
[/group]
[group COMPSYCH-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
COMPSYCH rate: $775
[/group]
[group COMPSYCH-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
COMPSYCH rate: $0
[/group]
[group COMPSYCH-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
COMPSYCH rate: $775
[/group]
[group COMPSYCH-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
COMPSYCH rate: $0
[/group]
[group COMPSYCH-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
COMPSYCH rate: $0
[/group]
[group GEHA-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
GEHA rate: $0
[/group]
[group GEHA-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
GEHA rate: $0
[/group]
[group GEHA-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
GEHA rate: $0
[/group]
[group GEHA-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
GEHA rate: $727
[/group]
[group GEHA-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
GEHA rate: $0
[/group]
[group GEHA-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
GEHA rate: $796
[/group]
[group GEHA-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
GEHA rate: $0
[/group]
[group GEHA-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
GEHA rate: $796
[/group]
[group GEHA-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
GEHA rate: $0
[/group]
[group GEHA-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
GEHA rate: $700
[/group]
[group GHI-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
GHI rate: $0
[/group]
[group GHI-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
GHI rate: $0
[/group]
[group GHI-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
GHI rate: $0
[/group]
[group GHI-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
GHI rate: $700
[/group]
[group GHI-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
GHI rate: $0
[/group]
[group GHI-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
GHI rate: $700
[/group]
[group GHI-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
GHI rate: $0
[/group]
[group GHI-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
GHI rate: $700
[/group]
[group GHI-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
GHI rate: $0
[/group]
[group GHI-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
GHI rate: $538
[/group]
[group HUMANACOMMERCIAL-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
HUMANA COMMERCIAL rate: $0
[/group]
[group HUMANACOMMERCIAL-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
HUMANA COMMERCIAL rate: $0
[/group]
[group HUMANACOMMERCIAL-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
HUMANA COMMERCIAL rate: $0
[/group]
[group HUMANACOMMERCIAL-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
HUMANA COMMERCIAL rate: $900
[/group]
[group HUMANACOMMERCIAL-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
HUMANA COMMERCIAL rate: $0
[/group]
[group HUMANACOMMERCIAL-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
HUMANA COMMERCIAL rate: $900
[/group]
[group HUMANACOMMERCIAL-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
HUMANA COMMERCIAL rate: $0
[/group]
[group HUMANACOMMERCIAL-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
HUMANA COMMERCIAL rate: $900
[/group]
[group HUMANACOMMERCIAL-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
HUMANA COMMERCIAL rate: $0
[/group]
[group HUMANACOMMERCIAL-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
HUMANA COMMERCIAL rate: $900
[/group]
[group HUMANAMEDICARE-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
HUMANA MEDICARE rate: $0
[/group]
[group HUMANAMEDICARE-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
HUMANA MEDICARE rate: $0
[/group]
[group HUMANAMEDICARE-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
HUMANA MEDICARE rate: $100
[/group]
[group HUMANAMEDICARE-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
HUMANA MEDICARE rate: $0
[/group]
[group HUMANAMEDICARE-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
HUMANA MEDICARE rate: $100
[/group]
[group HUMANAMEDICARE-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
HUMANA MEDICARE rate: $0
[/group]
[group HUMANAMEDICARE-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
HUMANA MEDICARE rate: $0
[/group]
[group HUMANAMEDICARE-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
HUMANA MEDICARE rate: $0
[/group]
[group HUMANAMEDICARE-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
HUMANA MEDICARE rate: $100
[/group]
[group HUMANAMEDICARE-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
HUMANA MEDICARE rate: $0
[/group]
[group MAGELLANPINNACLE-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
MAGELLAN PINNACLE rate: $0
[/group]
[group MAGELLANPINNACLE-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
MAGELLAN PINNACLE rate: $0
[/group]
[group MAGELLANPINNACLE-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
MAGELLAN PINNACLE rate: $100
[/group]
[group MAGELLANPINNACLE-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
MAGELLAN PINNACLE rate: $0
[/group]
[group MAGELLANPINNACLE-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
MAGELLAN PINNACLE rate: $100
[/group]
[group MAGELLANPINNACLE-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
MAGELLAN PINNACLE rate: $0
[/group]
[group MAGELLANPINNACLE-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
MAGELLAN PINNACLE rate: $0
[/group]
[group MAGELLANPINNACLE-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
MAGELLAN PINNACLE rate: $0
[/group]
[group MAGELLANPINNACLE-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
MAGELLAN PINNACLE rate: $100
[/group]
[group MAGELLANPINNACLE-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
MAGELLAN PINNACLE rate: $0
[/group]
[group MAGELLANPINNACLE-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
MAGELLAN PINNACLE rate: $0
[/group]
[group MAGELLANPINNACLE-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
MAGELLAN PINNACLE rate: $0
[/group]
[group MAGELLANPINNACLE-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
MAGELLAN PINNACLE rate: $0
[/group]
[group MAGELLANPINNACLE-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
MAGELLAN PINNACLE rate: $1,699
[/group]
[group MAGELLANPINNACLE-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
MAGELLAN PINNACLE rate: $0
[/group]
[group MAGELLANPINNACLE-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
MAGELLAN PINNACLE rate: $1,699
[/group]
[group MAGELLANPINNACLE-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
MAGELLAN PINNACLE rate: $0
[/group]
[group MAGELLANPINNACLE-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
MAGELLAN PINNACLE rate: $1,699
[/group]
[group MAGELLANPINNACLE-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
MAGELLAN PINNACLE rate: $0
[/group]
[group MAGELLANPINNACLE-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
MAGELLAN PINNACLE rate: $1,699
[/group]
[group MAGELLANSUMMIT-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
MAGELLAN SUMMIT rate: $0
[/group]
[group MAGELLANSUMMIT-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
MAGELLAN SUMMIT rate: $0
[/group]
[group MAGELLANSUMMIT-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
MAGELLAN SUMMIT rate: $0
[/group]
[group MAGELLANSUMMIT-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
MAGELLAN SUMMIT rate: $1,699
[/group]
[group MAGELLANSUMMIT-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
MAGELLAN SUMMIT rate: $0
[/group]
[group MAGELLANSUMMIT-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
MAGELLAN SUMMIT rate: $1,699
[/group]
[group MAGELLANSUMMIT-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
MAGELLAN SUMMIT rate: $0
[/group]
[group MAGELLANSUMMIT-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
MAGELLAN SUMMIT rate: $1,699
[/group]
[group MAGELLANSUMMIT-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
MAGELLAN SUMMIT rate: $0
[/group]
[group MAGELLANSUMMIT-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
MAGELLAN SUMMIT rate: $1,699
[/group]
[group MOLINAHEALTHCARE-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
MOLINA HEALTHCARE rate: $0
[/group]
[group MOLINAHEALTHCARE-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
MOLINA HEALTHCARE rate: $0
[/group]
[group MOLINAHEALTHCARE-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
MOLINA HEALTHCARE rate: $0
[/group]
[group MOLINAHEALTHCARE-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
MOLINA HEALTHCARE rate: $750
[/group]
[group MOLINAHEALTHCARE-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
MOLINA HEALTHCARE rate: $0
[/group]
[group MOLINAHEALTHCARE-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
MOLINA HEALTHCARE rate: $750
[/group]
[group MOLINAHEALTHCARE-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
MOLINA HEALTHCARE rate: $0
[/group]
[group MOLINAHEALTHCARE-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
MOLINA HEALTHCARE rate: $750
[/group]
[group MOLINAHEALTHCARE-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
MOLINA HEALTHCARE rate: $0
[/group]
[group MOLINAHEALTHCARE-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
MOLINA HEALTHCARE rate: $750
[/group]
[group STUDENTRESOURCES-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
STUDENT RESOURCES rate: $0
[/group]
[group STUDENTRESOURCES-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
STUDENT RESOURCES rate: $0
[/group]
[group STUDENTRESOURCES-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
STUDENT RESOURCES rate: $0
[/group]
[group STUDENTRESOURCES-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
STUDENT RESOURCES rate: $730
[/group]
[group STUDENTRESOURCES-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
STUDENT RESOURCES rate: $0
[/group]
[group STUDENTRESOURCES-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
STUDENT RESOURCES rate: $707
[/group]
[group STUDENTRESOURCES-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
STUDENT RESOURCES rate: $0
[/group]
[group STUDENTRESOURCES-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
STUDENT RESOURCES rate: $707
[/group]
[group STUDENTRESOURCES-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
STUDENT RESOURCES rate: $0
[/group]
[group STUDENTRESOURCES-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
STUDENT RESOURCES rate: $707
[/group]
[group TRICAREEAST-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
TRICARE EAST rate: $0
[/group]
[group TRICAREEAST-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
TRICARE EAST rate: $0
[/group]
[group TRICAREEAST-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
TRICARE EAST rate: $0
[/group]
[group TRICAREEAST-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
TRICARE EAST rate: $1,160.10
[/group]
[group TRICAREEAST-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
TRICARE EAST rate: $0
[/group]
[group TRICAREEAST-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
TRICARE EAST rate: $1,160.10
[/group]
[group TRICAREEAST-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
TRICARE EAST rate: $0
[/group]
[group TRICAREEAST-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
TRICARE EAST rate: $1,160.10
[/group]
[group TRICAREEAST-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
TRICARE EAST rate: $0
[/group]
[group TRICAREEAST-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
TRICARE EAST rate: $1,160.10
[/group]
[group UBH/OPTUMMCAID-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
UBH/OPTUM MCAID rate: $0
[/group]
[group UBH/OPTUMMCAID-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
UBH/OPTUM MCAID rate: $0
[/group]
[group UBH/OPTUMMCAID-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
UBH/OPTUM MCAID rate: $0
[/group]
[group UBH/OPTUMMCAID-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
UBH/OPTUM MCAID rate: $700
[/group]
[group UBH/OPTUMMCAID-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
UBH/OPTUM MCAID rate: $0
[/group]
[group UBH/OPTUMMCAID-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
UBH/OPTUM MCAID rate: $660
[/group]
[group UBH/OPTUMMCAID-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
UBH/OPTUM MCAID rate: $0
[/group]
[group UBH/OPTUMMCAID-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
UBH/OPTUM MCAID rate: $660
[/group]
[group UBH/OPTUMMCAID-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
UBH/OPTUM MCAID rate: $0
[/group]
[group UBH/OPTUMMCAID-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
UBH/OPTUM MCAID rate: $660
[/group]
[group UBH/OPTUMMEDICARE-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
UBH/OPTUM MEDICARE rate: $830
[/group]
[group UBH/OPTUMMEDICARE-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
UBH/OPTUM MEDICARE rate: $0
[/group]
[group UBH/OPTUMMEDICARE-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
UBH/OPTUM MEDICARE rate: $0
[/group]
[group UBH/OPTUMMEDICARE-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
UBH/OPTUM MEDICARE rate: $785
[/group]
[group UBH/OPTUMMEDICARE-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
UBH/OPTUM MEDICARE rate: $0
[/group]
[group UBH/OPTUMMEDICARE-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
UBH/OPTUM MEDICARE rate: $785
[/group]
[group UBH/OPTUMMEDICARE-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
UBH/OPTUM MEDICARE rate: $0
[/group]
[group UBH/OPTUMMEDICARE-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
UBH/OPTUM MEDICARE rate: $0
[/group]
[group UBH/OPTUMMEDICARE-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
UBH/OPTUM MEDICARE rate: $0
[/group]
[group UBH/OPTUMMEDICARE-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
UBH/OPTUM MEDICARE rate: $785
[/group]
[group UMR-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
UMR rate: $0
[/group]
[group UMR-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
UMR rate: $0
[/group]
[group UMR-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
UMR rate: $0
[/group]
[group UMR-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
UMR rate: $730
[/group]
[group UMR-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
UMR rate: $0
[/group]
[group UMR-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
UMR rate: $707
[/group]
[group UMR-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
UMR rate: $0
[/group]
[group UMR-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
UMR rate: $707
[/group]
[group UMR-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
UMR rate: $0
[/group]
[group UMR-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
UMR rate: $707
[/group]
[group UMRORLANDOHEALTH-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
UMR ORLANDO HEALTH rate: $0
[/group]
[group UMRORLANDOHEALTH-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
UMR ORLANDO HEALTH rate: $0
[/group]
[group UMRORLANDOHEALTH-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
UMR ORLANDO HEALTH rate: $0
[/group]
[group UMRORLANDOHEALTH-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
UMR ORLANDO HEALTH rate: $775
[/group]
[group UMRORLANDOHEALTH-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
UMR ORLANDO HEALTH rate: $0
[/group]
[group UMRORLANDOHEALTH-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
UMR ORLANDO HEALTH rate: $775
[/group]
[group UMRORLANDOHEALTH-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
UMR ORLANDO HEALTH rate: $0
[/group]
[group UMRORLANDOHEALTH-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
UMR ORLANDO HEALTH rate: $775
[/group]
[group UMRORLANDOHEALTH-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
UMR ORLANDO HEALTH rate: $0
[/group]
[group UMRORLANDOHEALTH-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
UMR ORLANDO HEALTH rate: $775
[/group]
[group UNITEDBEHAVIORAL-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
UNITED BEHAVIORAL rate: $0
[/group]
[group UNITEDBEHAVIORAL-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
UNITED BEHAVIORAL rate: $0
[/group]
[group UNITEDBEHAVIORAL-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
UNITED BEHAVIORAL rate: $0
[/group]
[group UNITEDBEHAVIORAL-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
UNITED BEHAVIORAL rate: $730
[/group]
[group UNITEDBEHAVIORAL-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
UNITED BEHAVIORAL rate: $0
[/group]
[group UNITEDBEHAVIORAL-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
UNITED BEHAVIORAL rate: $707
[/group]
[group UNITEDBEHAVIORAL-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
UNITED BEHAVIORAL rate: $0
[/group]
[group UNITEDBEHAVIORAL-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
UNITED BEHAVIORAL rate: $707
[/group]
[group UNITEDBEHAVIORAL-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
UNITED BEHAVIORAL rate: $0
[/group]
[group UNITEDBEHAVIORAL-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
UNITED BEHAVIORAL rate: $707
[/group]
[group VALUEOPTIONS-3]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
VALUE OPTIONS rate: $0
[/group]
[group VALUEOPTIONS-4]
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
VALUE OPTIONS rate: $0
[/group]
[group VALUEOPTIONS-5]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
VALUE OPTIONS rate: $0
[/group]
[group VALUEOPTIONS-6]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $690
De-Identified (high rate): $1,160.10
VALUE OPTIONS rate: $750
[/group]
[group VALUEOPTIONS-7]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
VALUE OPTIONS rate: $0
[/group]
[group VALUEOPTIONS-8]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
VALUE OPTIONS rate: $772
[/group]
[group VALUEOPTIONS-9]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
VALUE OPTIONS rate: $0
[/group]
[group VALUEOPTIONS-10]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $650
De-Identified (high rate): $1,160.10
VALUE OPTIONS rate: $772
[/group]
[group VALUEOPTIONS-11]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
VALUE OPTIONS rate: $0
[/group]
[group VALUEOPTIONS-12]
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $538
De-Identified (high rate): $1,160.10
VALUE OPTIONS rate: $650
[/group]
