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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
$225.11 / $225.11 / $225.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $227.36 / $272.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.35 / $229.35 / $229.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.48 / $225.11 / $280.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$261.27 / $322.02 / $617.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.32 / $225.19 / $247.71
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$264.38 / $270.23 / $386.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.47 / $267.43 / $590.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.35 / $246.35 / $246.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $247.62
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.19 / $225.19 / $225.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.19 / $225.19 / $225.19