ST. LUKE’S CHARGE 10000461 MR ABDOMEN W/O DYE Insurance and Self Pay Discounts 610 74181 $4,040.00

Aurora ST. LUKE’S
CHARGE
10000461
MR ABDOMEN W/O DYE
Rev 610
CPT 74181
NDC NA

Fee $4,040.00

Self-Pay $1,789.42

Insurance

Minimum $2,020.00
Maximum $3,383.50
Aetna W $1,250.42
Aetna PPO $3,298.94
Anthem Blue Priority $1,442.30
Anthem Blue Preferred $1,442.30
Anthem PPO $3,383.50
Aurora Caregiver $1,303.13
Centivo $1,382.92
Cigna GPPO $2,206.52
Cigna PPO $3,381.62
Common Ground ETF Network $1,304.35
Common Ground Exchange Envision $1,304.35
Common Ground Group Envision $1,304.35
Everpointe Elite $1,385.21
Health EOS Plus $2,441.32
Health EOS PPO $3,181.50
HealthPartners ETF $1,465.11
HealthPartners Robin Focused $1,821.23
HealthPartners Broad $3,001.15
HPS $1,503.85
HST $1,609.81
Humana HPN $1,546.55
Humana HMO $1,546.55
Humana PPO $3,360.08
Molina Exchange $1,437.39
Quartz One $1,375.37
Quartz Group $1,511.84
Trilogy $1,668.83
UHC Individual Exchange $1,324.16
UHC Charter $1,339.56
UHC Nexus $1,339.56
UHC HMO $1,445.43
UHC PPO $3,360.71
WPS Aurora Featured Network $1,699.95
WPS Arise $1,789.42
WPS Statewide $1,789.42