ST. LUKE’S CHARGE 10002520 PRIMIDONE Insurance and Self Pay Discounts 301 80188 $165.00

Aurora ST. LUKE’S
CHARGE
10002520
PRIMIDONE
Rev 301
CPT 80188
NDC NA

Fee $165.00

Self-Pay $78.63

Insurance

Minimum $82.50
Maximum $138.19
Aetna W $61.84
Aetna PPO $135.03
Anthem Blue Priority $60.45
Anthem Blue Preferred $60.45
Anthem PPO $138.19
Aurora Caregiver $62.02
Centivo $66.42
Cigna GPPO $99.17
Cigna PPO $138.06
Common Ground ETF Network $65.03
Common Ground Exchange Envision $65.03
Common Ground Group Envision $65.03
Everpointe Elite $60.03
Health EOS Plus $99.67
Health EOS PPO $129.89
HealthPartners ETF $63.83
HealthPartners Robin Focused $78.12
HealthPartners Broad $122.53
HPS $76.42
HST $79.12
Humana HPN $67.05
Humana HMO $67.05
Humana PPO $137.03
Molina Exchange $67.16
Quartz One $66.16
Quartz Group $74.40
Trilogy $83.89
UHC Individual Exchange $62.78
UHC Charter $62.78
UHC Nexus $62.78
UHC HMO $67.50
UHC PPO $137.21
WPS Aurora Featured Network $74.70
WPS Arise $78.63
WPS Statewide $78.63