ST. LUKE’S CHARGE 10002800 CEMIPLIMAB-RWLC 350 MG/7ML IV SOLN Insurance and Self Pay Discounts 250 J9119 61755-008-01 $209.49

Aurora ST. LUKE’S
CHARGE
10002800
CEMIPLIMAB-RWLC 350 MG/7ML IV SOLN
Rev 250
CPT J9119
NDC 61755-008-01

Fee $209.49

Self-Pay $112.68

Insurance

Minimum $104.75
Maximum $178.07
Aetna W $96.16
Aetna PPO $174.72
Anthem Blue Priority $61.01
Anthem Blue Preferred $61.01
Anthem PPO $178.07
Aurora Caregiver $45.78
Centivo $56.58
Cigna GPPO $125.54
Cigna PPO $177.22
Common Ground ETF Network $59.95
Common Ground Exchange Envision $59.95
Common Ground Group Envision $59.95
Everpointe Elite $58.32
Health EOS Plus $127.79
Health EOS PPO $167.59
HealthPartners ETF $54.65
HealthPartners Robin Focused $68.18
HealthPartners Broad $157.12
HPS $61.84
HST $101.86
Humana HPN $47.54
Humana HMO $47.54
Humana PPO $177.22
Molina Exchange $102.32
Quartz One $101.85
Quartz Group $122.19
Trilogy $113.76
UHC Individual Exchange $48.64
UHC Charter $48.64
UHC Nexus $48.64
UHC HMO $49.26
UHC PPO $177.23
WPS Aurora Featured Network $107.05
WPS Arise $112.68
WPS Statewide $112.68