ST. LUKE’S CHARGE 10002800 EPINEPHRINE 0.4 MG/25 ML IN D5W INFUSION SYR 16 MCG/ML Insurance and Self Pay Discounts 250 J0171 99999-581-99 $134.42

Aurora ST. LUKE’S
CHARGE
10002800
EPINEPHRINE 0.4 MG/25 ML IN D5W INFUSION SYR 16 MCG/ML
Rev 250
CPT J0171
NDC 99999-581-99

Fee $134.42

Self-Pay $65.23

Insurance

Minimum $67.21
Maximum $113.10
Aetna W $56.98
Aetna PPO $110.64
Anthem Blue Priority $60.03
Anthem Blue Preferred $60.03
Anthem PPO $113.10
Aurora Caregiver $62.07
Centivo $64.47
Cigna GPPO $85.83
Cigna PPO $112.89
Common Ground ETF Network $61.62
Common Ground Exchange Envision $61.62
Common Ground Group Envision $61.62
Everpointe Elite $56.95
Health EOS Plus $81.47
Health EOS PPO $106.38
HealthPartners ETF $57.67
HealthPartners Robin Focused $72.60
HealthPartners Broad $100.16
HPS $73.65
HST $71.76
Humana HPN $67.67
Humana HMO $67.67
Humana PPO $112.39
Molina Exchange $59.78
Quartz One $57.80
Quartz Group $65.10
Trilogy $77.97
UHC Individual Exchange $52.97
UHC Charter $52.97
UHC Nexus $52.97
UHC HMO $57.83
UHC PPO $112.42
WPS Aurora Featured Network $61.97
WPS Arise $65.23
WPS Statewide $65.23