ST. LUKE’S CHARGE 10002800 MEASLES, MUMPS & RUBELLA VAC IJ SOLR Insurance and Self Pay Discounts 250 90707 0006-4681-00 $618.36

Aurora ST. LUKE’S
CHARGE
10002800
MEASLES, MUMPS & RUBELLA VAC IJ SOLR
Rev 250
CPT 90707
NDC 0006-4681-00

Fee $618.36

Self-Pay $325.22

Insurance

Minimum $309.18
Maximum $525.60
Aetna W $307.34
Aetna PPO $515.70
Anthem Blue Priority $275.14
Anthem Blue Preferred $275.14
Anthem PPO $525.60
Aurora Caregiver $254.92
Centivo $243.36
Cigna GPPO $370.56
Cigna PPO $523.08
Common Ground ETF Network $274.55
Common Ground Exchange Envision $274.55
Common Ground Group Envision $274.55
Everpointe Elite $244.77
Health EOS Plus $377.20
Health EOS PPO $494.69
HealthPartners ETF $272.78
HealthPartners Robin Focused $327.04
HealthPartners Broad $463.77
HPS $305.91
HST $295.57
Humana HPN $81.29
Humana HMO $81.29
Humana PPO $523.08
Molina Exchange $339.07
Quartz One $290.90
Quartz Group $346.66
Trilogy $332.70
UHC Individual Exchange $78.38
UHC Charter $78.38
UHC Nexus $78.38
UHC HMO $80.15
UHC PPO $523.13
WPS Aurora Featured Network $308.96
WPS Arise $325.22
WPS Statewide $325.22