ST. LUKE’S CHARGE 10000632 US PELVIS LIMITED Insurance and Self Pay Discounts 402 76857 $875.00

Aurora ST. LUKE’S
CHARGE
10000632
US PELVIS LIMITED
Rev 402
CPT 76857
NDC NA

Fee $875.00

Self-Pay $498.95

Insurance

Minimum $437.50
Maximum $743.75
Aetna W $316.23
Aetna PPO $729.73
Anthem Blue Priority $355.17
Anthem Blue Preferred $355.17
Anthem PPO $743.75
Aurora Caregiver $324.36
Centivo $379.11
Cigna GPPO $513.74
Cigna PPO $740.18
Common Ground ETF Network $367.85
Common Ground Exchange Envision $367.85
Common Ground Group Envision $367.85
Everpointe Elite $380.97
Health EOS Plus $533.75
Health EOS PPO $700.00
HealthPartners ETF $362.25
HealthPartners Robin Focused $462.36
HealthPartners Broad $656.25
HPS $498.27
HST $408.56
Humana HPN $425.91
Humana HMO $425.91
Humana PPO $740.18
Molina Exchange $386.63
Quartz One $339.09
Quartz Group $378.88
Trilogy $524.87
UHC Individual Exchange $467.80
UHC Charter $473.24
UHC Nexus $473.24
UHC HMO $516.31
UHC PPO $740.25
WPS Aurora Featured Network $474.00
WPS Arise $498.95
WPS Statewide $498.95