ST. LUKE’S CHARGE 10002800 DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN Insurance and Self Pay Discounts 250 J1100 55150-304-25 $61.84

Aurora ST. LUKE’S
CHARGE
10002800
DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN
Rev 250
CPT J1100
NDC 55150-304-25

Fee $61.84

Self-Pay $32.29

Insurance

Minimum $30.92
Maximum $52.52
Aetna W $22.67
Aetna PPO $51.45
Anthem Blue Priority $21.71
Anthem Blue Preferred $21.71
Anthem PPO $52.52
Aurora Caregiver $22.43
Centivo $24.01
Cigna GPPO $35.83
Cigna PPO $52.20
Common Ground ETF Network $22.13
Common Ground Exchange Envision $22.13
Common Ground Group Envision $22.13
Everpointe Elite $21.03
Health EOS Plus $37.65
Health EOS PPO $49.35
HealthPartners ETF $22.24
HealthPartners Robin Focused $27.44
HealthPartners Broad $46.28
HPS $26.25
HST $30.57
Humana HPN $23.64
Humana HMO $23.64
Humana PPO $52.18
Molina Exchange $24.79
Quartz One $26.72
Quartz Group $30.74
Trilogy $33.96
UHC Individual Exchange $23.56
UHC Charter $23.56
UHC Nexus $23.56
UHC HMO $25.34
UHC PPO $52.18
WPS Aurora Featured Network $30.68
WPS Arise $32.29
WPS Statewide $32.29