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South Dakota rates for HCPCS J1303

Injection, ravulizumab-cwvz, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $446.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $380.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $229.09 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $229.09 / $288.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $323.59 / $616.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $223.87 / $223.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $223.87 / $245.47
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87