ST. LUKE’S CHARGE 10002800 INCOBOTULINUMTOXINA 100 UNITS IM SOLR Insurance and Self Pay Discounts 250 J0588 0259-1610-01 $96.65

Aurora ST. LUKE’S
CHARGE
10002800
INCOBOTULINUMTOXINA 100 UNITS IM SOLR
Rev 250
CPT J0588
NDC 0259-1610-01

Fee $96.65

Self-Pay $50.37

Insurance

Minimum $48.33
Maximum $81.49
Aetna W $38.58
Aetna PPO $78.89
Anthem Blue Priority $29.45
Anthem Blue Preferred $29.45
Anthem PPO $81.49
Aurora Caregiver $25.46
Centivo $29.03
Cigna GPPO $57.00
Cigna PPO $80.35
Common Ground ETF Network $29.52
Common Ground Exchange Envision $29.52
Common Ground Group Envision $29.52
Everpointe Elite $27.84
Health EOS Plus $58.04
Health EOS PPO $75.78
HealthPartners ETF $27.69
HealthPartners Robin Focused $34.15
HealthPartners Broad $71.30
HPS $32.02
HST $47.11
Humana HPN $26.24
Humana HMO $26.24
Humana PPO $80.02
Molina Exchange $41.25
Quartz One $44.69
Quartz Group $52.83
Trilogy $51.84
UHC Individual Exchange $26.32
UHC Charter $26.32
UHC Nexus $26.32
UHC HMO $27.48
UHC PPO $80.01
WPS Aurora Featured Network $47.85
WPS Arise $50.37
WPS Statewide $50.37