ST. LUKE’S CHARGE 10002800 EPOETIN ALFA 3000 UNIT/ML IJ SOLN Insurance and Self Pay Discounts 250 J0885 55513-267-01 $176.69

Aurora ST. LUKE’S
CHARGE
10002800
EPOETIN ALFA 3000 UNIT/ML IJ SOLN
Rev 250
CPT J0885
NDC 55513-267-01

Fee $176.69

Self-Pay $92.09

Insurance

Minimum $88.35
Maximum $148.97
Aetna W $70.53
Aetna PPO $144.22
Anthem Blue Priority $53.83
Anthem Blue Preferred $53.83
Anthem PPO $148.97
Aurora Caregiver $46.54
Centivo $53.06
Cigna GPPO $104.20
Cigna PPO $146.88
Common Ground ETF Network $53.96
Common Ground Exchange Envision $53.96
Common Ground Group Envision $53.96
Everpointe Elite $50.89
Health EOS Plus $106.11
Health EOS PPO $138.54
HealthPartners ETF $50.61
HealthPartners Robin Focused $62.42
HealthPartners Broad $130.35
HPS $58.53
HST $86.13
Humana HPN $47.99
Humana HMO $47.99
Humana PPO $146.30
Molina Exchange $75.42
Quartz One $81.70
Quartz Group $96.57
Trilogy $94.76
UHC Individual Exchange $48.12
UHC Charter $48.12
UHC Nexus $48.12
UHC HMO $50.24
UHC PPO $146.28
WPS Aurora Featured Network $87.49
WPS Arise $92.09
WPS Statewide $92.09