ST. LUKE’S CHARGE 10002800 TREPROSTINIL-CADD-MS3 PUMP 10 MG/ML SUBCUTANEOUS INFUSION Insurance and Self Pay Discounts 250 J3285 66302-110-01 $555.00

Aurora ST. LUKE’S
CHARGE
10002800
TREPROSTINIL-CADD-MS3 PUMP 10 MG/ML SUBCUTANEOUS INFUSION
Rev 250
CPT J3285
NDC 66302-110-01

Fee $555.00

Self-Pay $206.90

Insurance

Minimum $277.50
Maximum $471.75
Aetna W $154.84
Aetna PPO $462.86
Anthem Blue Priority $179.86
Anthem Blue Preferred $179.86
Anthem PPO $471.75
Aurora Caregiver $193.67
Centivo $187.61
Cigna GPPO $259.46
Cigna PPO $469.48
Common Ground ETF Network $171.97
Common Ground Exchange Envision $171.97
Common Ground Group Envision $171.97
Everpointe Elite $169.57
Health EOS Plus $338.55
Health EOS PPO $444.00
HealthPartners ETF $182.34
HealthPartners Robin Focused $226.64
HealthPartners Broad $416.25
HPS $215.43
HST $230.07
Humana HPN $202.62
Humana HMO $202.62
Humana PPO $469.48
Molina Exchange $174.40
Quartz One $169.20
Quartz Group $187.99
Trilogy $215.00
UHC Individual Exchange $183.37
UHC Charter $183.37
UHC Nexus $183.37
UHC HMO $203.94
UHC PPO $469.53
WPS Aurora Featured Network $196.56
WPS Arise $206.90
WPS Statewide $206.90