ST. LUKE’S CHARGE 10001104 SEROTONIN Insurance and Self Pay Discounts 301 84260 $305.00

Aurora ST. LUKE’S
CHARGE
10001104
SEROTONIN
Rev 301
CPT 84260
NDC NA

Fee $305.00

Self-Pay $111.04

Insurance

Minimum $152.50
Maximum $259.25
Aetna W $89.69
Aetna PPO $254.36
Anthem Blue Priority $53.94
Anthem Blue Preferred $53.94
Anthem PPO $259.25
Aurora Caregiver $45.63
Centivo $67.37
Cigna GPPO $185.83
Cigna PPO $258.01
Common Ground ETF Network $67.50
Common Ground Exchange Envision $67.50
Common Ground Group Envision $67.50
Everpointe Elite $62.36
Health EOS Plus $186.05
Health EOS PPO $244.00
HealthPartners ETF $71.41
HealthPartners Robin Focused $90.13
HealthPartners Broad $228.75
HPS $77.67
HST $98.55
Humana HPN $53.20
Humana HMO $53.20
Humana PPO $258.01
Molina Exchange $99.41
Quartz One $95.10
Quartz Group $110.49
Trilogy $115.94
UHC Individual Exchange $42.46
UHC Charter $42.46
UHC Nexus $42.46
UHC HMO $43.10
UHC PPO $258.03
WPS Aurora Featured Network $105.49
WPS Arise $111.04
WPS Statewide $111.04