Ravulizumab injection (Ultomiris), per 10 mg at Southeast Texas - Jasper Memorial

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-sonnet-5-5
Provider: anthropic
API: message_batches
Reasoning effort: model default
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

INJ., RAVULIZUMAB-CWVZ 10 MG

Jasper, TX

See all hospitals reporting HCPCS J1303 →

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How this price compares nationally

Southeast Texas - Jasper Memorial’s median price of $238 is 34% below the median hospital's median price ($362), higher than 26% of the 1,645 hospitals reporting HCPCS J1303. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS J1303 at Southeast Texas - Jasper Memorial

Negotiated rates from the hospital’s own file: 7 payers, 19 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	UnitedHealthcare all payer fee schedule · outpatient	$220	$220	—	—	—	$220 – $220
2	UnitedHealthcare hix fee schedule · outpatient	$220	$220	—	—	—	$220 – $220
3	Aetna mm fee schedule · outpatient	$223	$223	—	—	—	$223 – $223
4	Bcbs Tx mm fee schedule · outpatient	$223	$223	—	—	—	$223 – $223
5	Humana gold choice mm fee schedule · outpatient	$223	$223	—	—	—	$223 – $223
6	Molina medicare adv mm fee schedule · outpatient	$223	$223	—	—	—	$223 – $223
7	UnitedHealthcare mm fee schedule · outpatient	$223	$223	—	—	—	$223 – $223
8	WellCare mm fee schedule · outpatient	$223	$223	—	—	—	$223 – $223
9	Devoted mm fee schedule · outpatient	$240	$240	—	—	—	$240 – $240
10	Aetna new business fee schedule · outpatient	$395	$395	—	—	—	$395 – $395
11	Aetna epo fee schedule · outpatient	$439	$439	—	—	—	$439 – $439
12	Aetna hmo fee schedule · outpatient	$439	$439	—	—	—	$439 – $439
13	Aetna pos fee schedule · outpatient	$439	$439	—	—	—	$439 – $439
14	Aetna ppo fee schedule · outpatient	$439	$439	—	—	—	$439 – $439
15	Bcbs Tx blue advantage hmo fee schedule · outpatient	$941	$941	—	—	—	$941 – $941
16	Bcbs Tx heb fee schedule · outpatient	$1.0k	$1.0k	—	—	—	$1.0k – $1.0k
17	Bcbs Tx hmo fee schedule · outpatient	$1.0k	$1.0k	—	—	—	$1.0k – $1.0k
18	Bcbs Tx ppo fee schedule · outpatient	$1.2k	$1.2k	—	—	—	$1.2k – $1.2k
19	Bcbs Tx traditional fee schedule · outpatient	$1.2k	$1.2k	—	—	—	$1.2k – $1.2k

Last updated: Jan 13, 2026

Compare to other hospitals

See Ravulizumab injection (Ultomiris), per 10 mg pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.