MANITOWOC CHARGE 10002800 VANCOMYCIN 1.75 GM/500 ML NS (PREMIX) Insurance and Self Pay Discounts 250 J3370 99999-818-99 $88.95

Aurora MANITOWOC
CHARGE
10002800
VANCOMYCIN 1.75 GM/500 ML NS (PREMIX)
Rev 250
CPT J3370
NDC 99999-818-99

Fee $88.95

Self-Pay $53.90

Insurance

Minimum $44.48
Maximum $75.60
Aetna W $41.19
Aetna PPO $74.18
Anthem Blue Priority $44.80
Anthem Blue Preferred $44.80
Anthem PPO $75.60
Aurora Caregiver $48.20
Centivo $49.48
Cigna GPPO $56.42
Cigna PPO $75.24
Common Ground ETF Network $47.11
Common Ground Exchange Envision $47.11
Common Ground Group Envision $47.11
Everpointe Elite $44.13
Health EOS Plus $54.26
Health EOS PPO $71.16
HealthPartners ETF $44.81
HealthPartners Robin Focused $53.65
HealthPartners Broad $66.71
HPS $50.00
HST $52.98
Humana HPN $51.66
Humana HMO $51.66
Humana PPO $75.24
Molina Exchange $48.87
Quartz One $43.67
Quartz Group $47.82
Trilogy $54.27
UHC Individual Exchange $46.91
UHC Charter $46.91
UHC Nexus $46.91
UHC HMO $50.46
UHC PPO $75.26
WPS Aurora Featured Network $51.21
WPS Arise $53.90
WPS Statewide $53.90