ST. LUKE’S CHARGE 10002023 POLYSOMNOGRAPHY W CPAP/BIPAP Insurance and Self Pay Discounts 920 95811 $6,480.00

Aurora ST. LUKE’S
CHARGE
10002023
POLYSOMNOGRAPHY W CPAP/BIPAP
Rev 920
CPT 95811
NDC NA

Fee $6,480.00

Self-Pay $2,764.09

Insurance

Minimum $3,240.00
Maximum $5,508.00
Aetna W $2,138.32
Aetna PPO $5,404.17
Anthem Blue Priority $2,463.50
Anthem Blue Preferred $2,463.50
Anthem PPO $5,508.00
Aurora Caregiver $2,415.15
Centivo $2,439.74
Cigna GPPO $3,886.73
Cigna PPO $5,481.56
Common Ground ETF Network $2,247.41
Common Ground Exchange Envision $2,247.41
Common Ground Group Envision $2,247.41
Everpointe Elite $2,455.60
Health EOS Plus $3,952.80
Health EOS PPO $5,184.00
HealthPartners ETF $2,331.09
HealthPartners Robin Focused $2,974.97
HealthPartners Broad $4,860.00
HPS $2,919.72
HST $2,947.27
Humana HPN $2,815.56
Humana HMO $2,815.56
Humana PPO $5,481.56
Molina Exchange $2,369.40
Quartz One $2,332.46
Quartz Group $2,586.72
Trilogy $2,813.27
UHC Individual Exchange $2,484.06
UHC Charter $2,512.96
UHC Nexus $2,512.96
UHC HMO $2,737.78
UHC PPO $5,482.08
WPS Aurora Featured Network $2,625.89
WPS Arise $2,764.09
WPS Statewide $2,764.09