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    [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]

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