ST. LUKE’S CHARGE 10002800 INSULIN 100 UNITS/100 ML NS (PREMIX) Insurance and Self Pay Discounts 250 J1815 0338-0126-12 $189.45

Aurora ST. LUKE’S
CHARGE
10002800
INSULIN 100 UNITS/100 ML NS (PREMIX)
Rev 250
CPT J1815
NDC 0338-0126-12

Fee $189.45

Self-Pay $101.48

Insurance

Minimum $94.73
Maximum $156.90
Aetna W $84.53
Aetna PPO $151.81
Anthem Blue Priority $90.89
Anthem Blue Preferred $90.89
Anthem PPO $156.32
Aurora Caregiver $95.36
Centivo $94.68
Cigna GPPO $117.65
Cigna PPO $156.90
Common Ground ETF Network $95.71
Common Ground Exchange Envision $95.71
Common Ground Group Envision $95.71
Everpointe Elite $86.92
Health EOS Plus $113.41
Health EOS PPO $146.84
HealthPartners ETF $88.21
HealthPartners Robin Focused $105.89
HealthPartners Broad $139.39
HPS $109.80
HST $110.09
Humana HPN $96.09
Humana HMO $96.09
Humana PPO $154.73
Molina Exchange $89.92
Quartz One $86.91
Quartz Group $96.81
Trilogy $108.48
UHC Individual Exchange $99.83
UHC Charter $99.83
UHC Nexus $99.83
UHC HMO $107.59
UHC PPO $154.94
WPS Aurora Featured Network $96.41
WPS Arise $101.48
WPS Statewide $101.48