ST. LUKE’S CHARGE 10000606 US ABDOMEN LTD Insurance and Self Pay Discounts 402 76705 $1,390.00

Aurora ST. LUKE’S
CHARGE
10000606
US ABDOMEN LTD
Rev 402
CPT 76705
NDC NA

Fee $1,390.00

Self-Pay $596.57

Insurance

Minimum $695.00
Maximum $1,181.50
Aetna W $430.59
Aetna PPO $1,153.21
Anthem Blue Priority $479.57
Anthem Blue Preferred $479.57
Anthem PPO $1,181.50
Aurora Caregiver $481.31
Centivo $517.09
Cigna GPPO $731.66
Cigna PPO $1,175.83
Common Ground ETF Network $493.38
Common Ground Exchange Envision $493.38
Common Ground Group Envision $493.38
Everpointe Elite $473.68
Health EOS Plus $847.90
Health EOS PPO $1,112.00
HealthPartners ETF $503.92
HealthPartners Robin Focused $629.40
HealthPartners Broad $1,042.50
HPS $616.99
HST $550.55
Humana HPN $561.46
Humana HMO $561.46
Humana PPO $1,169.84
Molina Exchange $491.91
Quartz One $446.64
Quartz Group $499.13
Trilogy $627.78
UHC Individual Exchange $574.04
UHC Charter $580.72
UHC Nexus $580.72
UHC HMO $630.83
UHC PPO $1,175.94
WPS Aurora Featured Network $566.74
WPS Arise $596.57
WPS Statewide $596.57