ST. LUKE’S CHARGE 10007008 FLT3 MUTATION ANALYSIS Insurance and Self Pay Discounts 310 81479 $970.00

Aurora ST. LUKE’S
CHARGE
10007008
FLT3 MUTATION ANALYSIS
Rev 310
CPT 81479
NDC NA

Fee $970.00

Self-Pay $511.12

Insurance

Minimum $485.00
Maximum $812.38
Aetna W $401.98
Aetna PPO $793.82
Anthem Blue Priority $392.92
Anthem Blue Preferred $392.92
Anthem PPO $812.38
Aurora Caregiver $403.09
Centivo $431.77
Cigna GPPO $644.64
Cigna PPO $811.63
Common Ground ETF Network $422.65
Common Ground Exchange Envision $422.65
Common Ground Group Envision $422.65
Everpointe Elite $390.15
Health EOS Plus $585.96
Health EOS PPO $763.60
HealthPartners ETF $414.92
HealthPartners Robin Focused $507.76
HealthPartners Broad $720.32
HPS $496.74
HST $514.29
Humana HPN $435.84
Humana HMO $435.84
Humana PPO $805.59
Molina Exchange $436.52
Quartz One $430.04
Quartz Group $483.61
Trilogy $545.24
UHC Individual Exchange $408.09
UHC Charter $408.09
UHC Nexus $408.09
UHC HMO $438.75
UHC PPO $806.58
WPS Aurora Featured Network $485.56
WPS Arise $511.12
WPS Statewide $511.12