go back

Wisconsin rates for HCPCS J1303

Injection Ravulizumab-Cwvz 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.86 / $439.12 / $517.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $231.86 / $592.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.39 / $416.45 / $502.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $285.88
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$308.20 / $308.20 / $360.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.11 / $263.75 / $614.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $345.87 / $393.04
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.11 / $225.19 / $496.13
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.79 / $450.22 / $450.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.19 / $225.19 / $496.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.19 / $225.19 / $450.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $85.00 / $220.32
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.11 / $225.19 / $496.13
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.79 / $450.22 / $450.22
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $238.62 / $750.20
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,131.40 / $1,131.40 / $1,131.40
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $225.11
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.05 / $316.05 / $378.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.97 / $224.97 / $224.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $225.11 / $308.22