ST. LUKE’S CHARGE 10001348 AB, LYME DISEASE CONFIRMATORY Insurance and Self Pay Discounts 302 86617 $135.00

Aurora ST. LUKE’S
CHARGE
10001348
AB, LYME DISEASE CONFIRMATORY
Rev 302
CPT 86617
NDC NA

Fee $135.00

Self-Pay $51.21

Insurance

Minimum $67.50
Maximum $114.75
Aetna W $42.47
Aetna PPO $112.59
Anthem Blue Priority $45.69
Anthem Blue Preferred $45.69
Anthem PPO $114.75
Aurora Caregiver $48.41
Centivo $48.83
Cigna GPPO $72.60
Cigna PPO $114.20
Common Ground ETF Network $46.28
Common Ground Exchange Envision $46.28
Common Ground Group Envision $46.28
Everpointe Elite $44.19
Health EOS Plus $82.35
Health EOS PPO $108.00
HealthPartners ETF $45.12
HealthPartners Robin Focused $56.05
HealthPartners Broad $101.25
HPS $54.98
HST $56.45
Humana HPN $51.37
Humana HMO $51.37
Humana PPO $114.20
Molina Exchange $46.93
Quartz One $45.85
Quartz Group $51.03
Trilogy $56.72
UHC Individual Exchange $47.63
UHC Charter $47.63
UHC Nexus $47.63
UHC HMO $50.81
UHC PPO $114.21
WPS Aurora Featured Network $48.65
WPS Arise $51.21
WPS Statewide $51.21