ST. LUKE’S CHARGE 10006578 OPSCPY EXTND ON/MAC DRAW UNI/BI Insurance and Self Pay Discounts 920 92202 $160.00

Aurora ST. LUKE’S
CHARGE
10006578
OPSCPY EXTND ON/MAC DRAW UNI/BI
Rev 920
CPT 92202
NDC NA

Fee $160.00

Self-Pay $101.42

Insurance

Minimum $80.00
Maximum $136.00
Aetna W $81.58
Aetna PPO $133.31
Anthem Blue Priority $92.10
Anthem Blue Preferred $92.10
Anthem PPO $136.00
Aurora Caregiver $91.81
Centivo $114.56
Cigna GPPO $94.59
Cigna PPO $135.35
Common Ground ETF Network $90.99
Common Ground Exchange Envision $90.99
Common Ground Group Envision $90.99
Everpointe Elite $76.80
Health EOS Plus $97.60
Health EOS PPO $128.00
HealthPartners ETF $91.83
HealthPartners Robin Focused $107.43
HealthPartners Broad $120.00
HPS $100.88
HST $77.11
Humana HPN $107.06
Humana HMO $107.06
Humana PPO $135.22
Molina Exchange $91.89
Quartz One $76.77
Quartz Group $91.94
Trilogy $108.49
UHC Individual Exchange $45.22
UHC Charter $45.75
UHC Nexus $45.75
UHC HMO $49.74
UHC PPO $135.36
WPS Aurora Featured Network $96.35
WPS Arise $101.42
WPS Statewide $101.42