ST. LUKE’S CHARGE 10002572 ACTH STIMULATION PANEL Insurance and Self Pay Discounts 301 80400 $390.00

Aurora ST. LUKE’S
CHARGE
10002572
ACTH STIMULATION PANEL
Rev 301
CPT 80400
NDC NA

Fee $390.00

Self-Pay $155.73

Insurance

Minimum $195.00
Maximum $331.50
Aetna W $127.17
Aetna PPO $325.25
Anthem Blue Priority $129.30
Anthem Blue Preferred $129.30
Anthem PPO $331.50
Aurora Caregiver $123.63
Centivo $137.04
Cigna GPPO $251.20
Cigna PPO $329.91
Common Ground ETF Network $139.37
Common Ground Exchange Envision $139.37
Common Ground Group Envision $139.37
Everpointe Elite $115.47
Health EOS Plus $237.90
Health EOS PPO $312.00
HealthPartners ETF $125.31
HealthPartners Robin Focused $153.24
HealthPartners Broad $292.50
HPS $157.24
HST $157.88
Humana HPN $136.20
Humana HMO $136.20
Humana PPO $329.91
Molina Exchange $150.73
Quartz One $139.61
Quartz Group $161.13
Trilogy $171.36
UHC Individual Exchange $147.86
UHC Charter $147.86
UHC Nexus $147.86
UHC HMO $161.60
UHC PPO $329.94
WPS Aurora Featured Network $147.94
WPS Arise $155.73
WPS Statewide $155.73