Intravitreal pegcetacoplan injection

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Pegcetacoplan (Syfovre) Intravitreal Inj

Payers reporting HCPCS J2781

Payer pricing summary

Low

$72

Average

$2.0k

Median

$314

High

$18.5k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +19 other terms	540	$209	$220	$151	69%	—	$1 – $1.7k
2	Aetna fee schedule · outpatient · +21 other terms	359	$153	$264	$157	59%	—	$1 – $1.7k
3	Cigna fee schedule · outpatient · +17 other terms	325	$205	$345	$242	70%	—	$3 – $1.2k
4	Humana fee schedule · outpatient · +19 other terms	302	$140	$168	$177	105%	—	$1 – $1.8k
5	Blue Cross Blue Shield fee schedule · outpatient · +12 other terms	286	$228	$336	$241	72%	—	$1 – $1.2k
6	Molina fee schedule · outpatient · +16 other terms	127	$209	$289	$447	155%	—	$1 – $4.8k
7	WellCare fee schedule · outpatient · +10 other terms	114	$144	$162	$54	33%	—	$130 – $343
8	Anthem fee schedule · outpatient · +15 other terms	106	$198	$268	$243	91%	—	$132 – $1.7k
9	Caresource fee schedule · outpatient · +7 other terms	70	$159	$138	$66	48%	—	$1 – $271
10	Devoted fee schedule · outpatient · +3 other terms	65	$139	$141	$10	7%	—	$127 – $162
11	Kaiser fee schedule · outpatient · +8 other terms	55	$222	$281	$210	75%	—	$136 – $1.2k
12	Ambetter facility · fee schedule · outpatient · +7 other terms	51	$251	$274	$66	24%	—	$139 – $373
13	Optum fee schedule · outpatient · +11 other terms	34	$136	$180	$79	44%	—	$124 – $396
14	Bcbs Tx fee schedule · outpatient	31	$647	$602	$276	46%	—	$137 – $1.2k
15	Oscar facility · fee schedule · outpatient · +10 other terms	25	$186	$200	$37	19%	—	$138 – $273
16	Clover fee schedule · outpatient · +4 other terms	24	$158	$151	$13	9%	—	$132 – $172
17	Aetna Better Health fee schedule · outpatient · +8 other terms	22	$149	$152	$13	9%	—	$139 – $178
18	Medical Mutual facility · fee schedule · outpatient · +1 other terms	20	$209	$290	$141	49%	—	$80 – $606
19	Regence facility · fee schedule · outpatient · +4 other terms	20	$144	$162	$57	35%	—	$118 – $345
20	Healthpartners fee schedule · outpatient · +5 other terms	19	$175	$174	$5	3%	—	$151 – $179
21	Medicare fee schedule · outpatient · +5 other terms	18	$136	$136	$0	0%	—	$135 – $136
22	Highmark fee schedule · outpatient · +6 other terms	16	$191	$221	$308	140%	—	$77 – $4.8k
23	MultiPlan fee schedule · outpatient · +10 other terms	15	$252	$248	$20	8%	—	$142 – $252
24	Wellmark fee schedule · both · +4 other terms	14	$144	$144	$0	0%	—	$142 – $144
25	Bcbs Mn fee schedule · outpatient · +6 other terms	13	$142	$148	$5	4%	—	$142 – $156

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