ST. LUKE’S CHARGE 10002433 XR LOWER EXTREMITY INFANT 2 MINIMUM Insurance and Self Pay Discounts 320 73592 $425.00

Aurora ST. LUKE’S
CHARGE
10002433
XR LOWER EXTREMITY INFANT 2 MINIMUM
Rev 320
CPT 73592
NDC NA

Fee $425.00

Self-Pay $182.72

Insurance

Minimum $212.50
Maximum $357.00
Aetna W $140.82
Aetna PPO $349.38
Anthem Blue Priority $149.41
Anthem Blue Preferred $149.41
Anthem PPO $357.00
Aurora Caregiver $156.50
Centivo $169.67
Cigna GPPO $243.79
Cigna PPO $356.50
Common Ground ETF Network $155.37
Common Ground Exchange Envision $155.37
Common Ground Group Envision $155.37
Everpointe Elite $148.29
Health EOS Plus $257.31
Health EOS PPO $335.75
HealthPartners ETF $156.24
HealthPartners Robin Focused $195.91
HealthPartners Broad $316.33
HPS $199.92
HST $185.42
Humana HPN $188.44
Humana HMO $188.44
Humana PPO $354.51
Molina Exchange $162.20
Quartz One $147.37
Quartz Group $164.41
Trilogy $206.17
UHC Individual Exchange $171.85
UHC Charter $173.85
UHC Nexus $173.85
UHC HMO $188.13
UHC PPO $354.74
WPS Aurora Featured Network $173.58
WPS Arise $182.72
WPS Statewide $182.72