ST. LUKE’S CHARGE 10006732 CAR-T CELL ADMN AUTOLOGOUS Insurance and Self Pay Discounts 874 0540T $2,470.00

Aurora ST. LUKE’S
CHARGE
10006732
CAR-T CELL ADMN AUTOLOGOUS
Rev 874
CPT 0540T
NDC NA

Fee $2,470.00

Self-Pay $538.52

Insurance

Minimum $1,235.00
Maximum $2,099.50
Aetna W $495.47
Aetna PPO $571.42
Anthem Blue Priority $474.94
Anthem Blue Preferred $474.94
Anthem PPO $2,099.50
Aurora Caregiver $431.05
Centivo $496.08
Cigna GPPO $518.84
Cigna PPO $573.95
Common Ground ETF Network $486.83
Common Ground Exchange Envision $486.83
Common Ground Group Envision $486.83
Everpointe Elite $471.31
Health EOS Plus $524.30
Health EOS PPO $566.92
HealthPartners ETF $471.99
HealthPartners Robin Focused $493.03
HealthPartners Broad $554.13
HPS $513.95
HST $488.70
Humana HPN $453.50
Humana HMO $453.50
Humana PPO $537.90
Molina Exchange $1,199.95
Quartz One $462.20
Quartz Group $462.20
Trilogy $503.91
UHC Individual Exchange $454.37
UHC Charter $459.66
UHC Nexus $459.66
UHC HMO $459.66
UHC PPO $476.56
WPS Aurora Featured Network $511.59
WPS Arise $538.52
WPS Statewide $538.52