ST. LUKE’S CHARGE 10002089 SEDATION EA ADD’L 15 MIN Insurance and Self Pay Discounts 370 99153 $400.00

Aurora ST. LUKE’S
CHARGE
10002089
SEDATION EA ADD’L 15 MIN
Rev 370
CPT 99153
NDC NA

Fee $400.00

Self-Pay $253.07

Insurance

Minimum $200.00
Maximum $347.98
Aetna W $106.29
Aetna PPO $333.59
Anthem Blue Priority $101.48
Anthem Blue Preferred $101.48
Anthem PPO $340.00
Aurora Caregiver $215.54
Centivo $245.50
Cigna GPPO $347.98
Cigna PPO $338.37
Common Ground ETF Network $184.21
Common Ground Exchange Envision $184.21
Common Ground Group Envision $184.21
Everpointe Elite $175.49
Health EOS Plus $244.00
Health EOS PPO $320.00
HealthPartners ETF $148.10
HealthPartners Robin Focused $196.73
HealthPartners Broad $300.00
HPS $241.66
HST $251.13
Humana HPN $247.35
Humana HMO $247.35
Humana PPO $338.37
Molina Exchange $199.68
Quartz One $202.54
Quartz Group $224.64
Trilogy $274.27
UHC Individual Exchange $229.58
UHC Charter $232.25
UHC Nexus $232.25
UHC HMO $249.22
UHC PPO $338.40
WPS Aurora Featured Network $240.42
WPS Arise $253.07
WPS Statewide $253.07