ST. LUKE’S CHARGE 10002800 TERBUTALINE SULFATE 1 MG/ML IJ SOLN Insurance and Self Pay Discounts 250 J3105 0143-9746-10 $71.71

Aurora ST. LUKE’S
CHARGE
10002800
TERBUTALINE SULFATE 1 MG/ML IJ SOLN
Rev 250
CPT J3105
NDC 0143-9746-10

Fee $71.71

Self-Pay $37.38

Insurance

Minimum $35.86
Maximum $60.46
Aetna W $28.62
Aetna PPO $58.53
Anthem Blue Priority $21.85
Anthem Blue Preferred $21.85
Anthem PPO $60.46
Aurora Caregiver $18.89
Centivo $21.54
Cigna GPPO $42.29
Cigna PPO $59.62
Common Ground ETF Network $21.90
Common Ground Exchange Envision $21.90
Common Ground Group Envision $21.90
Everpointe Elite $20.65
Health EOS Plus $43.07
Health EOS PPO $56.23
HealthPartners ETF $20.54
HealthPartners Robin Focused $25.34
HealthPartners Broad $52.90
HPS $23.75
HST $34.96
Humana HPN $19.48
Humana HMO $19.48
Humana PPO $59.38
Molina Exchange $30.61
Quartz One $33.16
Quartz Group $39.20
Trilogy $38.47
UHC Individual Exchange $19.53
UHC Charter $19.53
UHC Nexus $19.53
UHC HMO $20.39
UHC PPO $59.37
WPS Aurora Featured Network $35.51
WPS Arise $37.38
WPS Statewide $37.38