ST. LUKE’S CHARGE 10002555 FLUOXETINE, HPLC 1-2 Insurance and Self Pay Discounts 301 80332 $260.00

Aurora ST. LUKE’S
CHARGE
10002555
FLUOXETINE, HPLC 1-2
Rev 301
CPT 80332
NDC NA

Fee $260.00

Self-Pay $127.78

Insurance

Minimum $130.00
Maximum $217.75
Aetna W $100.50
Aetna PPO $212.77
Anthem Blue Priority $98.23
Anthem Blue Preferred $98.23
Anthem PPO $217.75
Aurora Caregiver $100.77
Centivo $107.94
Cigna GPPO $161.16
Cigna PPO $217.55
Common Ground ETF Network $105.66
Common Ground Exchange Envision $105.66
Common Ground Group Envision $105.66
Everpointe Elite $97.54
Health EOS Plus $157.06
Health EOS PPO $204.68
HealthPartners ETF $103.73
HealthPartners Robin Focused $126.95
HealthPartners Broad $193.08
HPS $124.19
HST $128.57
Humana HPN $108.96
Humana HMO $108.96
Humana PPO $215.93
Molina Exchange $109.13
Quartz One $107.51
Quartz Group $120.90
Trilogy $136.31
UHC Individual Exchange $102.02
UHC Charter $102.02
UHC Nexus $102.02
UHC HMO $109.69
UHC PPO $216.20
WPS Aurora Featured Network $121.39
WPS Arise $127.78
WPS Statewide $127.78