ST. LUKE’S CHARGE 10001693 HIV-1 PHENOTYPE 1 TO 10 DRUGS Insurance and Self Pay Discounts 306 87903 $2,200.00

Aurora ST. LUKE’S
CHARGE
10001693
HIV-1 PHENOTYPE 1 TO 10 DRUGS
Rev 306
CPT 87903
NDC NA

Fee $2,200.00

Self-Pay $1,051.74

Insurance

Minimum $1,100.00
Maximum $1,842.49
Aetna W $827.15
Aetna PPO $1,800.43
Anthem Blue Priority $808.51
Anthem Blue Preferred $808.51
Anthem PPO $1,842.49
Aurora Caregiver $829.44
Centivo $888.44
Cigna GPPO $1,326.46
Cigna PPO $1,840.81
Common Ground ETF Network $869.68
Common Ground Exchange Envision $869.68
Common Ground Group Envision $869.68
Everpointe Elite $802.82
Health EOS Plus $1,329.00
Health EOS PPO $1,731.87
HealthPartners ETF $853.78
HealthPartners Robin Focused $1,044.83
HealthPartners Broad $1,633.72
HPS $1,022.12
HST $1,058.24
Humana HPN $896.84
Humana HMO $896.84
Humana PPO $1,827.12
Molina Exchange $898.22
Quartz One $884.87
Quartz Group $995.12
Trilogy $1,121.95
UHC Individual Exchange $839.72
UHC Charter $839.72
UHC Nexus $839.72
UHC HMO $902.81
UHC PPO $1,829.37
WPS Aurora Featured Network $999.15
WPS Arise $1,051.74
WPS Statewide $1,051.74