ST. LUKE’S CHARGE 10006639 ALIGNATE DRSG > 48SQ IN Insurance and Self Pay Discounts 623 A6198 $55.00

Aurora ST. LUKE’S
CHARGE
10006639
ALIGNATE DRSG > 48SQ IN
Rev 623
CPT A6198
NDC NA

Fee $55.00

Self-Pay $55.00

Insurance

Minimum $27.50
Maximum $55.00
Aetna W $53.35
Aetna PPO $45.87
Anthem Blue Priority $54.29
Anthem Blue Preferred $54.29
Anthem PPO $46.75
Aurora Caregiver $54.42
Centivo $54.61
Cigna GPPO $28.69
Cigna PPO $46.53
Common Ground ETF Network $19.54
Common Ground Exchange Envision $19.54
Common Ground Group Envision $19.54
Everpointe Elite $54.35
Health EOS Plus $33.55
Health EOS PPO $44.00
HealthPartners ETF $21.08
HealthPartners Robin Focused $28.03
HealthPartners Broad $41.25
HPS $55.00
HST $54.52
Humana HPN $54.17
Humana HMO $54.17
Humana PPO $46.53
Molina Exchange $54.45
Quartz One $54.33
Quartz Group $54.46
Trilogy $55.00
UHC Individual Exchange $20.70
UHC Charter $20.94
UHC Nexus $20.94
UHC HMO $22.54
UHC PPO $46.53
WPS Aurora Featured Network $52.25
WPS Arise $55.00
WPS Statewide $55.00