ST. LUKE’S CHARGE 10002395 INJECT ILEAL CONDUIT Insurance and Self Pay Discounts 360 50690 $1,220.00

Aurora ST. LUKE’S
CHARGE
10002395
INJECT ILEAL CONDUIT
Rev 360
CPT 50690
NDC NA

Fee $1,220.00

Self-Pay $550.41

Insurance

Minimum $610.00
Maximum $1,029.45
Aetna W $430.67
Aetna PPO $1,008.77
Anthem Blue Priority $444.89
Anthem Blue Preferred $444.89
Anthem PPO $1,029.45
Aurora Caregiver $489.61
Centivo $487.58
Cigna GPPO $619.59
Cigna PPO $1,026.65
Common Ground ETF Network $444.77
Common Ground Exchange Envision $444.77
Common Ground Group Envision $444.77
Everpointe Elite $445.06
Health EOS Plus $740.75
Health EOS PPO $968.45
HealthPartners ETF $497.57
HealthPartners Robin Focused $635.42
HealthPartners Broad $910.69
HPS $565.93
HST $554.75
Humana HPN $539.51
Humana HMO $539.51
Humana PPO $1,023.43
Molina Exchange $477.59
Quartz One $436.74
Quartz Group $485.18
Trilogy $611.53
UHC Individual Exchange $486.45
UHC Charter $492.11
UHC Nexus $492.11
UHC HMO $536.94
UHC PPO $1,023.57
WPS Aurora Featured Network $522.89
WPS Arise $550.41
WPS Statewide $550.41