ST. LUKE’S CHARGE 10001388 AB, HTLV WESTERN BLOT Insurance and Self Pay Discounts 302 86689 $215.00

Aurora ST. LUKE’S
CHARGE
10001388
AB, HTLV WESTERN BLOT
Rev 302
CPT 86689
NDC NA

Fee $215.00

Self-Pay $103.21

Insurance

Minimum $107.50
Maximum $180.06
Aetna W $81.16
Aetna PPO $175.95
Anthem Blue Priority $79.34
Anthem Blue Preferred $79.34
Anthem PPO $180.06
Aurora Caregiver $81.39
Centivo $87.18
Cigna GPPO $130.17
Cigna PPO $179.90
Common Ground ETF Network $85.34
Common Ground Exchange Envision $85.34
Common Ground Group Envision $85.34
Everpointe Elite $78.78
Health EOS Plus $129.88
Health EOS PPO $169.26
HealthPartners ETF $83.78
HealthPartners Robin Focused $102.53
HealthPartners Broad $159.66
HPS $100.30
HST $103.84
Humana HPN $88.00
Humana HMO $88.00
Humana PPO $178.56
Molina Exchange $88.15
Quartz One $86.83
Quartz Group $97.65
Trilogy $110.09
UHC Individual Exchange $82.40
UHC Charter $82.40
UHC Nexus $82.40
UHC HMO $88.59
UHC PPO $178.78
WPS Aurora Featured Network $98.05
WPS Arise $103.21
WPS Statewide $103.21