ST. LUKE’S CHARGE 10002800 POTASSIUM CHLORIDE IN NACL 40-0.9 MEQ/L-% IV SOLN Insurance and Self Pay Discounts 250 J3480 0338-0695-04 $184.52

Aurora ST. LUKE’S
CHARGE
10002800
POTASSIUM CHLORIDE IN NACL 40-0.9 MEQ/L-% IV SOLN
Rev 250
CPT J3480
NDC 0338-0695-04

Fee $184.52

Self-Pay $99.09

Insurance

Minimum $92.26
Maximum $154.13
Aetna W $85.92
Aetna PPO $150.54
Anthem Blue Priority $90.86
Anthem Blue Preferred $90.86
Anthem PPO $154.09
Aurora Caregiver $95.71
Centivo $95.74
Cigna GPPO $118.13
Cigna PPO $154.13
Common Ground ETF Network $96.72
Common Ground Exchange Envision $96.72
Common Ground Group Envision $96.72
Everpointe Elite $86.23
Health EOS Plus $111.29
Health EOS PPO $144.86
HealthPartners ETF $85.46
HealthPartners Robin Focused $103.10
HealthPartners Broad $136.82
HPS $111.16
HST $112.37
Humana HPN $96.68
Humana HMO $96.68
Humana PPO $152.82
Molina Exchange $90.16
Quartz One $88.79
Quartz Group $99.77
Trilogy $111.46
UHC Individual Exchange $94.12
UHC Charter $94.12
UHC Nexus $94.12
UHC HMO $102.39
UHC PPO $152.98
WPS Aurora Featured Network $94.14
WPS Arise $99.09
WPS Statewide $99.09