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Montana rates for HCPCS J1303

Injection, ravulizumab-cwvz, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $227.36 / $592.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.27 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.50 / $251.50 / $668.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $251.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.50 / $251.50 / $668.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $244.23 / $318.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $225.11