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Ohio rates for HCPCS J1303

Injection, ravulizumab-cwvz, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.11 / $488.49 / $749.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $227.36 / $400.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.12 / $362.43 / $562.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $389.80
Aultcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.64 / $301.64 / $301.64
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.11 / $225.11 / $382.69
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $303.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.37 / $212.37 / $225.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $342.59
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.59 / $316.95 / $488.82
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $342.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.62 / $281.48 / $326.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.97 / $224.97 / $224.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $243.48