ST. LUKE’S CHARGE 10006752 FLUOROESTRADIOL F 18 Insurance and Self Pay Discounts 343 A9591 $1,840.00

Aurora ST. LUKE’S
CHARGE
10006752
FLUOROESTRADIOL F 18
Rev 343
CPT A9591
NDC NA

Fee $1,840.00

Self-Pay $1,072.03

Insurance

Minimum $920.00
Maximum $1,563.52
Aetna W $840.69
Aetna PPO $1,533.85
Anthem Blue Priority $938.29
Anthem Blue Preferred $938.29
Anthem PPO $1,563.52
Aurora Caregiver $913.99
Centivo $1,056.20
Cigna GPPO $1,082.89
Cigna PPO $1,556.15
Common Ground ETF Network $927.17
Common Ground Exchange Envision $927.17
Common Ground Group Envision $927.17
Everpointe Elite $814.38
Health EOS Plus $1,122.18
Health EOS PPO $1,471.52
HealthPartners ETF $919.55
HealthPartners Robin Focused $1,106.57
HealthPartners Broad $1,379.73
HPS $999.53
HST $886.82
Humana HPN $1,141.74
Humana HMO $1,141.74
Humana PPO $1,555.94
Molina Exchange $807.87
Quartz One $816.56
Quartz Group $956.44
Trilogy $1,082.45
UHC Individual Exchange $458.98
UHC Charter $464.32
UHC Nexus $464.32
UHC HMO $551.98
UHC PPO $1,556.09
WPS Aurora Featured Network $1,018.43
WPS Arise $1,072.03
WPS Statewide $1,072.03