ST. LUKE’S CHARGE 10002800 PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR Insurance and Self Pay Discounts 250 J2543 60505-6159-4 $66.97

Aurora ST. LUKE’S
CHARGE
10002800
PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR
Rev 250
CPT J2543
NDC 60505-6159-4

Fee $66.97

Self-Pay $33.70

Insurance

Minimum $33.49
Maximum $56.34
Aetna W $26.69
Aetna PPO $55.08
Anthem Blue Priority $28.99
Anthem Blue Preferred $28.99
Anthem PPO $56.34
Aurora Caregiver $30.66
Centivo $30.46
Cigna GPPO $38.41
Cigna PPO $56.24
Common Ground ETF Network $30.40
Common Ground Exchange Envision $30.40
Common Ground Group Envision $30.40
Everpointe Elite $27.47
Health EOS Plus $40.59
Health EOS PPO $53.00
HealthPartners ETF $30.00
HealthPartners Robin Focused $36.50
HealthPartners Broad $49.90
HPS $35.54
HST $35.75
Humana HPN $31.34
Humana HMO $31.34
Humana PPO $55.85
Molina Exchange $28.09
Quartz One $27.62
Quartz Group $30.97
Trilogy $35.10
UHC Individual Exchange $32.46
UHC Charter $32.46
UHC Nexus $32.46
UHC HMO $35.39
UHC PPO $56.00
WPS Aurora Featured Network $32.02
WPS Arise $33.70
WPS Statewide $33.70