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New Hampshire rates for HCPCS J1303

Injection, ravulizumab-cwvz, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.19 / $252.21 / $450.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $225.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.45 / $382.69 / $983.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $225.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.37 / $225.11 / $225.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $225.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.19 / $365.58 / $694.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $225.11
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.51 / $299.61 / $3,000.00