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Pennsylvania rates for HCPCS J1303

Injection Ravulizumab-Cwvz 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.44 / $558.47 / $234,162.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $227.36 / $592.85
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.59 / $244.22 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.60 / $233.60 / $244.23
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
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.44 / $580.99 / $234,162.72
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $246.27 / $684.58
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.37 / $225.11 / $225.11
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $225.11
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.68 / $222.68 / $258.39
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.68 / $222.68 / $258.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $310.88