| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Premera BCBS
| Facility | $3,901,034.52 | $3,901,034.52 | $6,130,197.11 | |
Providence
| Facility | $3,901,034.52 | $5,572,906.46 | $9,195,295.66 |
Injection, onasemnogene abeparvovec-xioi, per treatment, up to 5x10^15 vector genomes
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Premera BCBS
| Facility | $3,901,034.52 | $3,901,034.52 | $6,130,197.11 | |
Providence
| Facility | $3,901,034.52 | $5,572,906.46 | $9,195,295.66 |