OSHKOSH CHARGE 10002657 RRX TC99M MEBROFENIN PER DOSE Insurance and Self Pay Discounts 343 A9537 $300.00

Aurora OSHKOSH
CHARGE
10002657
RRX TC99M MEBROFENIN PER DOSE
Rev 343
CPT A9537
NDC NA

Fee $300.00

Self-Pay $192.67

Insurance

Minimum $150.00
Maximum $293.55
Aetna W $163.92
Aetna PPO $250.19
Anthem Blue Priority $177.65
Anthem Blue Preferred $177.65
Anthem PPO $255.00
Aurora Caregiver $174.38
Centivo $218.16
Cigna GPPO $179.53
Cigna PPO $253.78
Common Ground ETF Network $175.49
Common Ground Exchange Envision $175.49
Common Ground Group Envision $175.49
Everpointe Elite $149.24
Health EOS Plus $183.00
Health EOS PPO $240.00
HealthPartners ETF $176.48
HealthPartners Robin Focused $207.03
HealthPartners Broad $225.00
HPS $193.46
HST $146.82
Humana HPN $293.55
Humana HMO $293.55
Humana PPO $253.78
Molina Exchange $227.47
Quartz One $146.61
Quartz Group $175.84
Trilogy $205.47
UHC Individual Exchange $177.11
UHC Charter $179.17
UHC Nexus $179.17
UHC HMO $210.14
UHC PPO $253.80
WPS Aurora Featured Network $183.04
WPS Arise $192.67
WPS Statewide $192.67