ST. LUKE’S CHARGE 10001364 AB, COXSACKIE A9 VIRUS Insurance and Self Pay Discounts 302 86658 $115.00

Aurora ST. LUKE’S
CHARGE
10001364
AB, COXSACKIE A9 VIRUS
Rev 302
CPT 86658
NDC NA

Fee $115.00

Self-Pay $54.06

Insurance

Minimum $57.50
Maximum $96.31
Aetna W $42.52
Aetna PPO $94.12
Anthem Blue Priority $41.56
Anthem Blue Preferred $41.56
Anthem PPO $96.31
Aurora Caregiver $42.63
Centivo $45.67
Cigna GPPO $68.18
Cigna PPO $96.22
Common Ground ETF Network $44.71
Common Ground Exchange Envision $44.71
Common Ground Group Envision $44.71
Everpointe Elite $41.26
Health EOS Plus $69.47
Health EOS PPO $90.53
HealthPartners ETF $43.89
HealthPartners Robin Focused $53.71
HealthPartners Broad $85.40
HPS $52.54
HST $54.39
Humana HPN $46.10
Humana HMO $46.10
Humana PPO $95.51
Molina Exchange $46.17
Quartz One $45.48
Quartz Group $51.15
Trilogy $57.67
UHC Individual Exchange $43.16
UHC Charter $43.16
UHC Nexus $43.16
UHC HMO $46.41
UHC PPO $95.63
WPS Aurora Featured Network $51.36
WPS Arise $54.06
WPS Statewide $54.06