ST. LUKE’S CHARGE 10006913 T-CELL GENE REARRANGEMENT PANEL Insurance and Self Pay Discounts 310 81479 $2,360.00

Aurora ST. LUKE’S
CHARGE
10006913
T-CELL GENE REARRANGEMENT PANEL
Rev 310
CPT 81479
NDC NA

Fee $2,360.00

Self-Pay $529.00

Insurance

Minimum $1,180.00
Maximum $1,996.09
Aetna W $396.09
Aetna PPO $1,955.99
Anthem Blue Priority $410.70
Anthem Blue Preferred $410.70
Anthem PPO $1,996.09
Aurora Caregiver $446.67
Centivo $476.98
Cigna GPPO $723.53
Cigna PPO $1,989.33
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 $1,435.06
Health EOS PPO $1,878.09
HealthPartners ETF $493.92
HealthPartners Robin Focused $625.44
HealthPartners Broad $1,764.34
HPS $555.59
HST $530.22
Humana HPN $504.00
Humana HMO $504.00
Humana PPO $1,985.10
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 $1,985.36
WPS Aurora Featured Network $502.55
WPS Arise $529.00
WPS Statewide $529.00