ST. LUKE’S CHARGE 10007138 PANCREATITIS PANEL Insurance and Self Pay Discounts 310 81479 $4,640.00

Aurora ST. LUKE’S
CHARGE
10007138
PANCREATITIS PANEL
Rev 310
CPT 81479
NDC NA

Fee $4,640.00

Self-Pay $529.00

Insurance

Minimum $2,320.00
Maximum $3,924.51
Aetna W $396.09
Aetna PPO $3,845.68
Anthem Blue Priority $410.70
Anthem Blue Preferred $410.70
Anthem PPO $3,924.51
Aurora Caregiver $446.67
Centivo $476.98
Cigna GPPO $723.53
Cigna PPO $3,911.22
Common Ground ETF Network $432.17
Common Ground Exchange Envision $432.17
Common Ground Group Envision $432.17
Everpointe Elite $407.01
Health EOS Plus $2,821.48
Health EOS PPO $3,692.51
HealthPartners ETF $493.92
HealthPartners Robin Focused $625.44
HealthPartners Broad $3,468.86
HPS $555.59
HST $530.22
Humana HPN $504.00
Humana HMO $504.00
Humana PPO $3,902.90
Molina Exchange $453.12
Quartz One $427.24
Quartz Group $477.50
Trilogy $599.04
UHC Individual Exchange $426.53
UHC Charter $426.53
UHC Nexus $426.53
UHC HMO $462.22
UHC PPO $3,903.41
WPS Aurora Featured Network $502.55
WPS Arise $529.00
WPS Statewide $529.00