ST. LUKE’S OP PROC* 66984 XCAPSL CTRC RMVL W/O ECP Insurance and Self Pay Discounts NA $15,028.68

Aurora ST. LUKE’S
OP PROC*
66984
XCAPSL CTRC RMVL W/O ECP
Rev NA
CPT NA
NDC NA

Fee $15,028.68

Self-Pay $4,201.45

Insurance

Minimum $7,514.34
Maximum $14,976.79
Aetna W $3,476.32
Aetna PPO $12,533.58
Anthem Blue Priority $3,738.55
Anthem Blue Preferred $3,738.55
Anthem PPO $12,774.37
Aurora Caregiver $3,513.90
Centivo $3,400.30
Cigna GPPO $14,976.79
Cigna PPO $12,713.06
Common Ground ETF Network $3,313.75
Common Ground Exchange Envision $3,313.75
Common Ground Group Envision $3,313.75
Everpointe Elite $3,023.66
Health EOS Plus $9,017.21
Health EOS PPO $12,022.94
HealthPartners ETF $5,536.46
HealthPartners Robin Focused $7,392.67
HealthPartners Broad $11,271.51
HPS $4,871.26
HST $4,280.59
Humana HPN $4,578.22
Humana HMO $4,578.22
Humana PPO $12,713.06
Molina Exchange $3,303.42
Quartz One $3,453.17
Quartz Group $3,829.98
Trilogy $4,562.60
UHC Individual Exchange $3,017.76
UHC Charter $3,052.87
UHC Nexus $3,052.87
UHC HMO $3,325.09
UHC PPO $12,714.26
WPS Aurora Featured Network $3,991.38
WPS Arise $4,201.45
WPS Statewide $4,201.45