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Utah rates for HCPCS J1303

Injection, ravulizumab-cwvz, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $588.84 / $89,125.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $229.09 / $257.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $316.23 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $426.58 / $831.76
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $234.42 / $281.84
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $223.87 / $269.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87