ST. LUKE’S CHARGE 10002800 ATEZOLIZUMAB 1200 MG/20ML IV SOLN Insurance and Self Pay Discounts 250 J9022 50242-917-01 $441.04

Aurora ST. LUKE’S
CHARGE
10002800
ATEZOLIZUMAB 1200 MG/20ML IV SOLN
Rev 250
CPT J9022
NDC 50242-917-01

Fee $441.04

Self-Pay $236.75

Insurance

Minimum $220.52
Maximum $374.89
Aetna W $189.33
Aetna PPO $367.82
Anthem Blue Priority $121.41
Anthem Blue Preferred $121.41
Anthem PPO $374.89
Aurora Caregiver $91.94
Centivo $113.95
Cigna GPPO $264.30
Cigna PPO $373.09
Common Ground ETF Network $119.54
Common Ground Exchange Envision $119.54
Common Ground Group Envision $119.54
Everpointe Elite $115.86
Health EOS Plus $269.03
Health EOS PPO $352.83
HealthPartners ETF $109.43
HealthPartners Robin Focused $136.31
HealthPartners Broad $330.78
HPS $123.69
HST $213.50
Humana HPN $96.23
Humana HMO $96.23
Humana PPO $373.09
Molina Exchange $201.14
Quartz One $213.40
Quartz Group $255.97
Trilogy $239.26
UHC Individual Exchange $98.83
UHC Charter $98.83
UHC Nexus $98.83
UHC HMO $100.45
UHC PPO $373.12
WPS Aurora Featured Network $224.91
WPS Arise $236.75
WPS Statewide $236.75