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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
$223.87 / $223.87 / $630.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $457.09 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $251.19 / $676.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $251.19
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $239.88 / $676.08
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $239.88 / $676.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $251.19 / $676.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $223.87 / $316.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87