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Maine rates for HCPCS J1303

Injection, ravulizumab-cwvz, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $562.34 / $562.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $229.09 / $269.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $263.03 / $707.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $269.15
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $562.34
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $239.88 / $346.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $323.59