ST. LUKE’S CHARGE 10000410 XR WRIST ARTHROGRAM S&I Insurance and Self Pay Discounts 320 73115 $1,250.00

Aurora ST. LUKE’S
CHARGE
10000410
XR WRIST ARTHROGRAM S&I
Rev 320
CPT 73115
NDC NA

Fee $1,250.00

Self-Pay $536.90

Insurance

Minimum $625.00
Maximum $1,050.01
Aetna W $413.79
Aetna PPO $1,027.58
Anthem Blue Priority $439.02
Anthem Blue Preferred $439.02
Anthem PPO $1,050.01
Aurora Caregiver $459.83
Centivo $498.54
Cigna GPPO $716.32
Cigna PPO $1,048.51
Common Ground ETF Network $456.50
Common Ground Exchange Envision $456.50
Common Ground Group Envision $456.50
Everpointe Elite $435.70
Health EOS Plus $756.79
Health EOS PPO $987.50
HealthPartners ETF $459.09
HealthPartners Robin Focused $575.63
HealthPartners Broad $930.36
HPS $587.42
HST $544.82
Humana HPN $553.69
Humana HMO $553.69
Humana PPO $1,042.70
Molina Exchange $476.59
Quartz One $433.02
Quartz Group $483.09
Trilogy $605.80
UHC Individual Exchange $504.93
UHC Charter $510.80
UHC Nexus $510.80
UHC HMO $552.78
UHC PPO $1,043.36
WPS Aurora Featured Network $510.06
WPS Arise $536.90
WPS Statewide $536.90