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Pricing Estimate

It is important to note, a hospital “charge” is not the same as “expected payment.” A charge is the amount billed for a service. In the vast majority of cases, hospitals are paid considerably less than the billed amount. Hospital charges are based on the type of care provided and can differ from patient to patient for the same service. The differences between patients are related to complications or varying treatments needed due to the patient’s health.

 

Even though the hospital’s prices on our list are the same for all patients, actual charges for each specific patient may vary from the listed standard charges due to a combination of factors.

 

The Healthcare Financial Management Association has published a booklet, “Understanding Healthcare Prices: A Consumer Guide,” which can help you better understand where to get answers to your questions about healthcare prices, how to compare prices among providers and how to manage your out-of-pocket costs. View the guidebook online →

View the Florida Health Price Finder →

Payment Estimate

Instructions
1. Select your insurance plan and the services using the dropdown boxes below.
2. To update your calculations, kindly refresh this page.

 

    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

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