ST. LUKE’S CHARGE 10001121 T4, TOTAL Insurance and Self Pay Discounts 301 84436 $140.00

Aurora ST. LUKE’S
CHARGE
10001121
T4, TOTAL
Rev 301
CPT 84436
NDC NA

Fee $140.00

Self-Pay $34.99

Insurance

Minimum $70.00
Maximum $119.00
Aetna W $29.95
Aetna PPO $116.76
Anthem Blue Priority $23.18
Anthem Blue Preferred $23.18
Anthem PPO $119.00
Aurora Caregiver $25.17
Centivo $29.80
Cigna GPPO $69.78
Cigna PPO $118.43
Common Ground ETF Network $30.26
Common Ground Exchange Envision $30.26
Common Ground Group Envision $30.26
Everpointe Elite $26.80
Health EOS Plus $85.40
Health EOS PPO $112.00
HealthPartners ETF $45.64
HealthPartners Robin Focused $57.09
HealthPartners Broad $105.00
HPS $37.89
HST $35.71
Humana HPN $29.13
Humana HMO $29.13
Humana PPO $118.43
Molina Exchange $29.86
Quartz One $28.05
Quartz Group $31.02
Trilogy $39.04
UHC Individual Exchange $38.48
UHC Charter $38.48
UHC Nexus $38.48
UHC HMO $41.79
UHC PPO $118.44
WPS Aurora Featured Network $33.24
WPS Arise $34.99
WPS Statewide $34.99