ST. LUKE’S CHARGE 10000363 CT L SPINE W/O DYE Insurance and Self Pay Discounts 350 72131 $2,800.00

Aurora ST. LUKE’S
CHARGE
10000363
CT L SPINE W/O DYE
Rev 350
CPT 72131
NDC NA

Fee $2,800.00

Self-Pay $1,299.28

Insurance

Minimum $1,400.00
Maximum $2,380.00
Aetna W $927.44
Aetna PPO $2,335.14
Anthem Blue Priority $1,005.81
Anthem Blue Preferred $1,005.81
Anthem PPO $2,380.00
Aurora Caregiver $935.44
Centivo $1,008.10
Cigna GPPO $1,549.63
Cigna PPO $2,368.58
Common Ground ETF Network $992.83
Common Ground Exchange Envision $992.83
Common Ground Group Envision $992.83
Everpointe Elite $963.51
Health EOS Plus $1,708.00
Health EOS PPO $2,240.00
HealthPartners ETF $974.09
HealthPartners Robin Focused $1,210.11
HealthPartners Broad $2,100.00
HPS $1,168.43
HST $1,213.63
Humana HPN $1,079.91
Humana HMO $1,079.91
Humana PPO $2,368.58
Molina Exchange $960.62
Quartz One $965.82
Quartz Group $1,083.23
Trilogy $1,237.27
UHC Individual Exchange $868.07
UHC Charter $878.17
UHC Nexus $878.17
UHC HMO $977.86
UHC PPO $2,368.80
WPS Aurora Featured Network $1,234.32
WPS Arise $1,299.28
WPS Statewide $1,299.28