ST. LUKE’S CHARGE 10002800 IRINOTECAN HCL 100 MG/5ML IV SOLN Insurance and Self Pay Discounts 250 J9206 45963-614-55 $86.85

Aurora ST. LUKE’S
CHARGE
10002800
IRINOTECAN HCL 100 MG/5ML IV SOLN
Rev 250
CPT J9206
NDC 45963-614-55

Fee $86.85

Self-Pay $47.11

Insurance

Minimum $43.43
Maximum $73.83
Aetna W $24.83
Aetna PPO $72.44
Anthem Blue Priority $20.57
Anthem Blue Preferred $20.57
Anthem PPO $73.83
Aurora Caregiver $18.23
Centivo $22.24
Cigna GPPO $52.04
Cigna PPO $73.47
Common Ground ETF Network $20.49
Common Ground Exchange Envision $20.49
Common Ground Group Envision $20.49
Everpointe Elite $18.45
Health EOS Plus $52.98
Health EOS PPO $69.48
HealthPartners ETF $19.91
HealthPartners Robin Focused $23.99
HealthPartners Broad $65.13
HPS $22.05
HST $41.06
Humana HPN $18.82
Humana HMO $18.82
Humana PPO $73.47
Molina Exchange $23.03
Quartz One $40.99
Quartz Group $49.14
Trilogy $48.21
UHC Individual Exchange $17.41
UHC Charter $17.41
UHC Nexus $17.41
UHC HMO $18.45
UHC PPO $73.48
WPS Aurora Featured Network $44.75
WPS Arise $47.11
WPS Statewide $47.11