ST. LUKE’S CHARGE 10001050 OLIGOCLONAL BANDS Insurance and Self Pay Discounts 301 83916 $180.00

Aurora ST. LUKE’S
CHARGE
10001050
OLIGOCLONAL BANDS
Rev 301
CPT 83916
NDC NA

Fee $180.00

Self-Pay $68.43

Insurance

Minimum $90.00
Maximum $153.00
Aetna W $57.91
Aetna PPO $150.12
Anthem Blue Priority $57.42
Anthem Blue Preferred $57.42
Anthem PPO $153.00
Aurora Caregiver $69.37
Centivo $64.46
Cigna GPPO $107.96
Cigna PPO $152.27
Common Ground ETF Network $59.86
Common Ground Exchange Envision $59.86
Common Ground Group Envision $59.86
Everpointe Elite $53.14
Health EOS Plus $109.80
Health EOS PPO $144.00
HealthPartners ETF $65.59
HealthPartners Robin Focused $82.71
HealthPartners Broad $135.00
HPS $78.01
HST $74.46
Humana HPN $69.21
Humana HMO $69.21
Humana PPO $152.27
Molina Exchange $58.71
Quartz One $57.14
Quartz Group $64.44
Trilogy $74.15
UHC Individual Exchange $78.10
UHC Charter $78.10
UHC Nexus $78.10
UHC HMO $83.67
UHC PPO $152.28
WPS Aurora Featured Network $65.01
WPS Arise $68.43
WPS Statewide $68.43