ST. LUKE’S CHARGE 10002800 ANTIHEMOPHILIC FACTOR-VWF 250-600 UNITS IV SOLR Insurance and Self Pay Discounts 250 J7187 63833-615-02 $66.54

Aurora ST. LUKE’S
CHARGE
10002800
ANTIHEMOPHILIC FACTOR-VWF 250-600 UNITS IV SOLR
Rev 250
CPT J7187
NDC 63833-615-02

Fee $66.54

Self-Pay $34.69

Insurance

Minimum $33.27
Maximum $56.10
Aetna W $26.56
Aetna PPO $54.32
Anthem Blue Priority $20.28
Anthem Blue Preferred $20.28
Anthem PPO $56.10
Aurora Caregiver $17.53
Centivo $19.98
Cigna GPPO $39.25
Cigna PPO $55.32
Common Ground ETF Network $20.32
Common Ground Exchange Envision $20.32
Common Ground Group Envision $20.32
Everpointe Elite $19.17
Health EOS Plus $39.97
Health EOS PPO $52.17
HealthPartners ETF $19.06
HealthPartners Robin Focused $23.51
HealthPartners Broad $49.09
HPS $22.05
HST $32.43
Humana HPN $18.08
Humana HMO $18.08
Humana PPO $55.09
Molina Exchange $28.41
Quartz One $30.77
Quartz Group $36.37
Trilogy $35.69
UHC Individual Exchange $18.12
UHC Charter $18.12
UHC Nexus $18.12
UHC HMO $18.92
UHC PPO $55.08
WPS Aurora Featured Network $32.96
WPS Arise $34.69
WPS Statewide $34.69