ST. LUKE’S CHARGE 10001432 AB, RUBEOLA IGM Insurance and Self Pay Discounts 302 86765 $155.00

Aurora ST. LUKE’S
CHARGE
10001432
AB, RUBEOLA IGM
Rev 302
CPT 86765
NDC NA

Fee $155.00

Self-Pay $83.16

Insurance

Minimum $77.50
Maximum $131.75
Aetna W $81.72
Aetna PPO $129.27
Anthem Blue Priority $58.24
Anthem Blue Preferred $58.24
Anthem PPO $131.75
Aurora Caregiver $47.65
Centivo $57.19
Cigna GPPO $94.49
Cigna PPO $131.12
Common Ground ETF Network $58.13
Common Ground Exchange Envision $58.13
Common Ground Group Envision $58.13
Everpointe Elite $54.39
Health EOS Plus $94.55
Health EOS PPO $124.00
HealthPartners ETF $54.98
HealthPartners Robin Focused $67.45
HealthPartners Broad $116.25
HPS $61.38
HST $73.59
Humana HPN $44.85
Humana HMO $44.85
Humana PPO $131.12
Molina Exchange $79.54
Quartz One $73.44
Quartz Group $87.93
Trilogy $84.70
UHC Individual Exchange $32.67
UHC Charter $32.67
UHC Nexus $32.67
UHC HMO $32.96
UHC PPO $131.13
WPS Aurora Featured Network $79.00
WPS Arise $83.16
WPS Statewide $83.16