ST. LUKE’S CHARGE 10000380 CT PELVIS W/DYE Insurance and Self Pay Discounts 350 72193 $3,000.00

Aurora ST. LUKE’S
CHARGE
10000380
CT PELVIS W/DYE
Rev 350
CPT 72193
NDC NA

Fee $3,000.00

Self-Pay $1,230.48

Insurance

Minimum $1,500.00
Maximum $2,550.00
Aetna W $899.17
Aetna PPO $2,501.93
Anthem Blue Priority $949.24
Anthem Blue Preferred $949.24
Anthem PPO $2,550.00
Aurora Caregiver $1,036.93
Centivo $1,079.14
Cigna GPPO $1,127.90
Cigna PPO $2,537.76
Common Ground ETF Network $999.44
Common Ground Exchange Envision $999.44
Common Ground Group Envision $999.44
Everpointe Elite $970.61
Health EOS Plus $1,830.00
Health EOS PPO $2,400.00
HealthPartners ETF $1,091.36
HealthPartners Robin Focused $1,405.91
HealthPartners Broad $2,250.00
HPS $1,284.24
HST $1,202.81
Humana HPN $1,223.50
Humana HMO $1,223.50
Humana PPO $2,537.76
Molina Exchange $1,018.96
Quartz One $965.47
Quartz Group $1,071.59
Trilogy $1,352.61
UHC Individual Exchange $1,013.23
UHC Charter $1,025.02
UHC Nexus $1,025.02
UHC HMO $1,121.85
UHC PPO $2,538.00
WPS Aurora Featured Network $1,168.96
WPS Arise $1,230.48
WPS Statewide $1,230.48