ST. LUKE’S CHARGE 10002687 MR BREAST W/WO W/CAD DYE BILAT Insurance and Self Pay Discounts 610 77049 $6,210.00

Aurora ST. LUKE’S
CHARGE
10002687
MR BREAST W/WO W/CAD DYE BILAT
Rev 610
CPT 77049
NDC NA

Fee $6,210.00

Self-Pay $1,942.75

Insurance

Minimum $3,105.00
Maximum $5,278.50
Aetna W $1,140.82
Aetna PPO $5,179.00
Anthem Blue Priority $1,266.77
Anthem Blue Preferred $1,266.77
Anthem PPO $5,278.50
Aurora Caregiver $672.60
Centivo $1,005.80
Cigna GPPO $3,811.14
Cigna PPO $5,253.16
Common Ground ETF Network $1,047.56
Common Ground Exchange Envision $1,047.56
Common Ground Group Envision $1,047.56
Everpointe Elite $1,273.51
Health EOS Plus $3,788.10
Health EOS PPO $4,968.00
HealthPartners ETF $927.87
HealthPartners Robin Focused $1,186.41
HealthPartners Broad $4,657.50
HPS $1,123.08
HST $1,368.94
Humana HPN $1,277.88
Humana HMO $1,277.88
Humana PPO $5,253.16
Molina Exchange $1,251.32
Quartz One $1,280.86
Quartz Group $1,427.20
Trilogy $1,528.26
UHC Individual Exchange $724.55
UHC Charter $732.98
UHC Nexus $732.98
UHC HMO $810.21
UHC PPO $5,253.66
WPS Aurora Featured Network $1,845.61
WPS Arise $1,942.75
WPS Statewide $1,942.75