ST. LUKE’S CHARGE 10002800 VANCOMYCIN HCL 750 MG IV SOLR Insurance and Self Pay Discounts 250 J3370 63323-203-20 $79.11

Aurora ST. LUKE’S
CHARGE
10002800
VANCOMYCIN HCL 750 MG IV SOLR
Rev 250
CPT J3370
NDC 63323-203-20

Fee $79.11

Self-Pay $43.27

Insurance

Minimum $39.56
Maximum $66.86
Aetna W $36.31
Aetna PPO $65.57
Anthem Blue Priority $39.18
Anthem Blue Preferred $39.18
Anthem PPO $66.86
Aurora Caregiver $40.94
Centivo $40.43
Cigna GPPO $50.33
Cigna PPO $66.65
Common Ground ETF Network $40.32
Common Ground Exchange Envision $40.32
Common Ground Group Envision $40.32
Everpointe Elite $36.66
Health EOS Plus $48.08
Health EOS PPO $62.91
HealthPartners ETF $37.48
HealthPartners Robin Focused $45.33
HealthPartners Broad $59.12
HPS $46.83
HST $47.13
Humana HPN $42.02
Humana HMO $42.02
Humana PPO $66.49
Molina Exchange $37.98
Quartz One $37.12
Quartz Group $41.46
Trilogy $46.46
UHC Individual Exchange $43.52
UHC Charter $43.52
UHC Nexus $43.52
UHC HMO $46.81
UHC PPO $66.50
WPS Aurora Featured Network $41.11
WPS Arise $43.27
WPS Statewide $43.27