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Vermont rates for HCPCS J1303

Injection Ravulizumab-Cwvz 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $386.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.84 / $254.84 / $254.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.37 / $249.42 / $415.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $225.11
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.37 / $249.42 / $415.69
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $225.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.85 / $225.11 / $346.29