Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
AETNA rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
AETNA rate: $0
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
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
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
AETNA BETTER rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
AETNA BETTER rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
ALL SAVERS rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
ALL SAVERS rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
AMBETTER COMMERCIAL rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
AMBETTER COMMERCIAL rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
BCBS MEDICARE rate: $960
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
BCBS MEDICARE rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
BEACON HEALTH STRATE rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
BEACON HEALTH STRATE rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
BEACON HLTH OPTIONS rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
BEACON HLTH OPTIONS rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
BLUE CROSS rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
BLUE CROSS rate: $960
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
BRIGHT HEALTH rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
BRIGHT HEALTH rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
CAREPLUS-MAGELLANH rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
CAREPLUS-MAGELLANH rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
CENPATICO rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
CENPATICO rate: $0
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
CENPATICO rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
CENPATICO rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
CENPATICO rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
CENPATICO rate: $0
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
CIGNA rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
CIGNA rate: $0
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
CIGNA rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
CIGNA rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
CIGNA rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
CIGNA rate: $0
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
CIGNA HEALTHSPRING rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
CIGNA HEALTHSPRING rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
COMPSYCH rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
COMPSYCH rate: $0
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
COMPSYCH rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
COMPSYCH rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
COMPSYCH rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
COMPSYCH rate: $0
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
GEHA rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
GEHA rate: $0
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
GEHA rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
GEHA rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
GEHA rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
GEHA rate: $0
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
GHI rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
GHI rate: $0
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
GHI rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
GHI rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
GHI rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
GHI rate: $0
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
HUMANA COMMERCIAL rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
HUMANA COMMERCIAL rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
HUMANA MEDICARE rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
HUMANA MEDICARE rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
MAGELLAN PINNACLE rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
MAGELLAN PINNACLE rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
MAGELLAN PINNACLE rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
MAGELLAN PINNACLE rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
MAGELLAN SUMMIT rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
MAGELLAN SUMMIT rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
MOLINA HEALTHCARE rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
MOLINA HEALTHCARE rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
STUDENT RESOURCES rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
STUDENT RESOURCES rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
TRICARE EAST rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
TRICARE EAST rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
UBH/OPTUM MCAID rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
UBH/OPTUM MCAID rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
UBH/OPTUM MEDICARE rate: $830
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
UBH/OPTUM MEDICARE rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
UMR rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
UMR rate: $0
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #126
De-Identified (low rate): $100
De-Identified (high rate): $110
UMR rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $100
De-Identified (high rate): $110
UMR rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #124
De-Identified (low rate): $110
De-Identified (high rate): $110
UMR rate: $0
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
Gross Charge: $2,200
Cash Price: $2,200
Billing Code: #128
De-Identified (low rate): $100
De-Identified (high rate): $110
UMR rate: $0
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
UMR ORLANDO HEALTH rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
UMR ORLANDO HEALTH rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
UNITED BEHAVIORAL rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
UNITED BEHAVIORAL rate: $0
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
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
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
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
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
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
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
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
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $830
De-Identified (high rate): $960
VALUE OPTIONS rate: $0
Gross Charge: $0
Cash Price: $0
Billing Code: #0
De-Identified (low rate): $960
De-Identified (high rate): $960
VALUE OPTIONS rate: $0
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
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
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
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
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
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
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
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
