ST. LUKE’S CHARGE 10001992 MAX VOLUNTARY VENTILATION Insurance and Self Pay Discounts 460 94200 $220.00

Aurora ST. LUKE’S
CHARGE
10001992
MAX VOLUNTARY VENTILATION
Rev 460
CPT 94200
NDC NA

Fee $220.00

Self-Pay $138.38

Insurance

Minimum $110.00
Maximum $187.00
Aetna W $110.98
Aetna PPO $183.48
Anthem Blue Priority $125.20
Anthem Blue Preferred $125.20
Anthem PPO $187.00
Aurora Caregiver $124.73
Centivo $155.82
Cigna GPPO $132.29
Cigna PPO $186.10
Common Ground ETF Network $123.53
Common Ground Exchange Envision $123.53
Common Ground Group Envision $123.53
Everpointe Elite $105.63
Health EOS Plus $134.20
Health EOS PPO $176.00
HealthPartners ETF $125.54
HealthPartners Robin Focused $147.70
HealthPartners Broad $165.00
HPS $140.75
HST $107.09
Humana HPN $147.04
Humana HMO $147.04
Humana PPO $186.10
Molina Exchange $101.05
Quartz One $104.80
Quartz Group $124.99
Trilogy $150.70
UHC Individual Exchange $78.81
UHC Charter $79.73
UHC Nexus $79.73
UHC HMO $86.88
UHC PPO $186.12
WPS Aurora Featured Network $131.46
WPS Arise $138.38
WPS Statewide $138.38