ST. LUKE’S CHARGE 10000657 GALACTOGRAM 1 DUCT S&I Insurance and Self Pay Discounts 320 77053 $580.00

Aurora ST. LUKE’S
CHARGE
10000657
GALACTOGRAM 1 DUCT S&I
Rev 320
CPT 77053
NDC NA

Fee $580.00

Self-Pay $261.69

Insurance

Minimum $290.00
Maximum $487.20
Aetna W $201.68
Aetna PPO $476.79
Anthem Blue Priority $213.98
Anthem Blue Preferred $213.98
Anthem PPO $487.20
Aurora Caregiver $224.11
Centivo $242.99
Cigna GPPO $349.12
Cigna PPO $486.51
Common Ground ETF Network $222.49
Common Ground Exchange Envision $222.49
Common Ground Group Envision $222.49
Everpointe Elite $212.36
Health EOS Plus $351.15
Health EOS PPO $458.20
HealthPartners ETF $223.76
HealthPartners Robin Focused $280.56
HealthPartners Broad $431.69
HPS $286.30
HST $265.54
Humana HPN $269.86
Humana HMO $269.86
Humana PPO $483.82
Molina Exchange $232.29
Quartz One $211.06
Quartz Group $235.46
Trilogy $295.27
UHC Individual Exchange $246.10
UHC Charter $248.96
UHC Nexus $248.96
UHC HMO $269.43
UHC PPO $484.12
WPS Aurora Featured Network $248.61
WPS Arise $261.69
WPS Statewide $261.69