ST. LUKE’S CHARGE 10006534 EEG W/VIDEO EA 12-26H CONT MNTR Insurance and Self Pay Discounts 740 95716 $5,730.00

Aurora ST. LUKE’S
CHARGE
10006534
EEG W/VIDEO EA 12-26H CONT MNTR
Rev 740
CPT 95716
NDC NA

Fee $5,730.00

Self-Pay $2,517.25

Insurance

Minimum $2,865.00
Maximum $4,870.50
Aetna W $2,011.44
Aetna PPO $4,778.69
Anthem Blue Priority $2,228.12
Anthem Blue Preferred $2,228.12
Anthem PPO $4,870.50
Aurora Caregiver $2,349.12
Centivo $2,382.67
Cigna GPPO $3,086.03
Cigna PPO $4,847.12
Common Ground ETF Network $2,231.54
Common Ground Exchange Envision $2,231.54
Common Ground Group Envision $2,231.54
Everpointe Elite $2,051.68
Health EOS Plus $3,495.30
Health EOS PPO $4,584.00
HealthPartners ETF $2,131.15
HealthPartners Robin Focused $2,604.77
HealthPartners Broad $4,297.50
HPS $2,610.70
HST $2,566.33
Humana HPN $2,455.17
Humana HMO $2,455.17
Humana PPO $4,847.12
Molina Exchange $2,163.50
Quartz One $2,079.04
Quartz Group $2,344.68
Trilogy $2,642.50
UHC Individual Exchange $2,232.95
UHC Charter $2,258.93
UHC Nexus $2,258.93
UHC HMO $2,445.90
UHC PPO $4,847.58
WPS Aurora Featured Network $2,391.39
WPS Arise $2,517.25
WPS Statewide $2,517.25