ST. LUKE’S CHARGE 10002800 INSULIN REGULAR HUMAN 100 UNIT/ML IJ SOLN Insurance and Self Pay Discounts 250 J1815 0002-8215-17 $62.26

Aurora ST. LUKE’S
CHARGE
10002800
INSULIN REGULAR HUMAN 100 UNIT/ML IJ SOLN
Rev 250
CPT J1815
NDC 0002-8215-17

Fee $62.26

Self-Pay $33.35

Insurance

Minimum $31.13
Maximum $51.56
Aetna W $27.79
Aetna PPO $49.89
Anthem Blue Priority $29.87
Anthem Blue Preferred $29.87
Anthem PPO $51.37
Aurora Caregiver $31.34
Centivo $31.12
Cigna GPPO $38.67
Cigna PPO $51.56
Common Ground ETF Network $31.46
Common Ground Exchange Envision $31.46
Common Ground Group Envision $31.46
Everpointe Elite $28.57
Health EOS Plus $37.27
Health EOS PPO $48.26
HealthPartners ETF $29.00
HealthPartners Robin Focused $34.80
HealthPartners Broad $45.81
HPS $36.09
HST $36.18
Humana HPN $31.58
Humana HMO $31.58
Humana PPO $50.85
Molina Exchange $29.55
Quartz One $28.56
Quartz Group $31.82
Trilogy $35.65
UHC Individual Exchange $32.81
UHC Charter $32.81
UHC Nexus $32.81
UHC HMO $35.36
UHC PPO $50.92
WPS Aurora Featured Network $31.68
WPS Arise $33.35
WPS Statewide $33.35