ST. LUKE’S CHARGE 10000286 XR DENTAL COMPLETE Insurance and Self Pay Discounts 320 70320 $425.00

Aurora ST. LUKE’S
CHARGE
10000286
XR DENTAL COMPLETE
Rev 320
CPT 70320
NDC NA

Fee $425.00

Self-Pay $180.40

Insurance

Minimum $212.50
Maximum $352.47
Aetna W $155.61
Aetna PPO $342.64
Anthem Blue Priority $161.14
Anthem Blue Preferred $161.14
Anthem PPO $351.33
Aurora Caregiver $168.46
Centivo $171.27
Cigna GPPO $194.58
Cigna PPO $352.47
Common Ground ETF Network $170.61
Common Ground Exchange Envision $170.61
Common Ground Group Envision $170.61
Everpointe Elite $155.76
Health EOS Plus $254.72
Health EOS PPO $330.08
HealthPartners ETF $186.43
HealthPartners Robin Focused $231.20
HealthPartners Broad $313.08
HPS $202.88
HST $198.22
Humana HPN $172.99
Humana HMO $172.99
Humana PPO $348.24
Molina Exchange $167.07
Quartz One $152.65
Quartz Group $171.69
Trilogy $202.38
UHC Individual Exchange $171.80
UHC Charter $173.80
UHC Nexus $173.80
UHC HMO $187.85
UHC PPO $348.33
WPS Aurora Featured Network $171.38
WPS Arise $180.40
WPS Statewide $180.40