ST. LUKE’S CHARGE 10002800 ERIBULIN MESYLATE 1 MG/2ML IV SOLN Insurance and Self Pay Discounts 250 J9179 62856-389-01 $565.42

Aurora ST. LUKE’S
CHARGE
10002800
ERIBULIN MESYLATE 1 MG/2ML IV SOLN
Rev 250
CPT J9179
NDC 62856-389-01

Fee $565.42

Self-Pay $302.38

Insurance

Minimum $282.71
Maximum $480.61
Aetna W $240.99
Aetna PPO $471.54
Anthem Blue Priority $155.56
Anthem Blue Preferred $155.56
Anthem PPO $480.61
Aurora Caregiver $118.40
Centivo $146.93
Cigna GPPO $338.83
Cigna PPO $478.30
Common Ground ETF Network $153.29
Common Ground Exchange Envision $153.29
Common Ground Group Envision $153.29
Everpointe Elite $148.22
Health EOS Plus $344.91
Health EOS PPO $452.33
HealthPartners ETF $140.61
HealthPartners Robin Focused $174.98
HealthPartners Broad $424.07
HPS $158.76
HST $272.25
Humana HPN $124.27
Humana HMO $124.27
Humana PPO $478.30
Molina Exchange $264.69
Quartz One $272.13
Quartz Group $326.40
Trilogy $305.75
UHC Individual Exchange $146.51
UHC Charter $146.51
UHC Nexus $146.51
UHC HMO $150.51
UHC PPO $478.35
WPS Aurora Featured Network $287.26
WPS Arise $302.38
WPS Statewide $302.38