ST. LUKE’S CHARGE 10002285 CATH VENOUS 1ST ORDER Insurance and Self Pay Discounts 360 36011 $1,450.00

Aurora ST. LUKE’S
CHARGE
10002285
CATH VENOUS 1ST ORDER
Rev 360
CPT 36011
NDC NA

Fee $1,450.00

Self-Pay $647.71

Insurance

Minimum $725.00
Maximum $1,232.51
Aetna W $501.75
Aetna PPO $1,209.27
Anthem Blue Priority $473.69
Anthem Blue Preferred $473.69
Anthem PPO $1,232.51
Aurora Caregiver $483.83
Centivo $567.90
Cigna GPPO $745.12
Cigna PPO $1,226.58
Common Ground ETF Network $468.54
Common Ground Exchange Envision $468.54
Common Ground Group Envision $468.54
Everpointe Elite $509.04
Health EOS Plus $884.50
Health EOS PPO $1,160.00
HealthPartners ETF $533.80
HealthPartners Robin Focused $712.77
HealthPartners Broad $1,087.50
HPS $693.18
HST $581.84
Humana HPN $668.97
Humana HMO $668.97
Humana PPO $1,226.58
Molina Exchange $594.65
Quartz One $468.29
Quartz Group $520.18
Trilogy $760.05
UHC Individual Exchange $875.70
UHC Charter $885.89
UHC Nexus $885.89
UHC HMO $965.18
UHC PPO $1,226.70
WPS Aurora Featured Network $615.32
WPS Arise $647.71
WPS Statewide $647.71