Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION
Low
$171
Average
$11.9k
Median
$225
High
$93.7k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
111 hospitals; the 90th percentile is 215.8× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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115 hospital rates
iThe hospitals that file a Tricare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY other · outpatient | 1 | $225 | $225 | — | — | — | $225 – $225 |
| 2 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $22.8k | $42.8k | $29.0k | 68% | — | $21.9k – $83.8k |
| 3 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $223 | $223 | — | — | — | $223 – $223 |
| 4 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $32.1k | $32.1k | — | — | — | $32.1k – $32.1k |
| 5 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $221 | $221 | — | — | — | $221 – $221 |
| 6 | Boston Medical Center Boston, MA other · both | 1 | $214 | $214 | — | — | — | $214 – $214 |
| 7 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $225 | $225 | — | — | — | $225 – $225 |
| 8 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $214 | $214 | — | — | — | $214 – $214 |
| 9 | CORNING HOSPITAL Corning, NY facility · other · outpatient | 2 | $23.6k | $79.6k | $107.0k | 134% | — | $6.8k – $264.5k |
| 10 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $214 | $214 | — | — | — | $214 – $214 |
| 11 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $225 | $225 | — | — | — | $225 – $225 |
| 12 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $23.2k | $23.2k | $13.3k | 57% | — | $9.9k – $36.5k |
| 13 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $225 | $225 | — | — | — | $225 – $225 |
| 14 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $225 | $225 | — | — | — | $225 – $225 |
| 15 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $12.5k | $12.5k | $6.8k | 54% | — | $5.7k – $19.3k |
| 16 | EAST BATON ROUGE MEDICAL CENTER, LLC Baton Rouge, LA other · outpatient | 1 | $225 | $225 | — | — | — | $225 – $225 |
| 17 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · both | 1 | $200 | $200 | — | — | — | $200 – $200 |
| 18 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $200 | $200 | — | — | — | $200 – $200 |
| 19 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient | 1 | $24.8k | $24.8k | — | — | — | $24.8k – $24.8k |
| 20 | HOSPITAL SERVICE DISTRICT NO. 1 OF THE PARISH OF ST. CHARLES, STATE OF LOUISIANA LULING, LA other · outpatient | 1 | $208 | $208 | $6 | 3% | — | $203 – $214 |
| 21 | HOSPITAL SERVICE DISTRICT OF THE PARISH OF ST. BERNARD, STATE OF LOUISIANA Chalmette, LA other · outpatient | 1 | $214 | $214 | — | — | — | $214 – $214 |
| 22 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 2 | $225 | $225 | — | — | — | $225 – $225 |
| 23 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $223 | $223 | — | — | — | $223 – $223 |
| 24 | Hospital Service District #1, Parish of Terrebonne, State of Louisiana dba Terrebonne General Health System Houma, LA facility · fee schedule · outpatient | 1 | $93.7k | $93.7k | $53.6k | 57% | — | $40.2k – $147.3k |
| 25 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient | 1 | $221 | $221 | — | — | — | $221 – $221 |
← Payers reporting HCPCS J1303 · Snapshot 20261111T120946Z-9134e7f7