ST. LUKE’S CHARGE 10002065 IV PUSH EA ADDL SAME DRUG Insurance and Self Pay Discounts 260 96376 $165.00

Aurora ST. LUKE’S
CHARGE
10002065
IV PUSH EA ADDL SAME DRUG
Rev 260
CPT 96376
NDC NA

Fee $165.00

Self-Pay $69.80

Insurance

Minimum $82.50
Maximum $140.25
Aetna W $49.74
Aetna PPO $137.02
Anthem Blue Priority $53.69
Anthem Blue Preferred $53.69
Anthem PPO $140.25
Aurora Caregiver $56.94
Centivo $55.74
Cigna GPPO $90.01
Cigna PPO $139.58
Common Ground ETF Network $49.48
Common Ground Exchange Envision $49.48
Common Ground Group Envision $49.48
Everpointe Elite $49.75
Health EOS Plus $100.65
Health EOS PPO $132.00
HealthPartners ETF $55.01
HealthPartners Robin Focused $69.79
HealthPartners Broad $123.75
HPS $61.12
HST $66.31
Humana HPN $60.24
Humana HMO $60.24
Humana PPO $139.00
Molina Exchange $53.64
Quartz One $56.92
Quartz Group $64.10
Trilogy $70.82
UHC Individual Exchange $52.74
UHC Charter $53.35
UHC Nexus $53.35
UHC HMO $58.03
UHC PPO $139.59
WPS Aurora Featured Network $66.31
WPS Arise $69.80
WPS Statewide $69.80