go back

Illinois rates for HCPCS J3399

Injection, onasemnogene abeparvovec-xioi, per treatment, up to 5x10^15 vector genomes

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090,295.43 / $3,467,368.50 / $4,265,795.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041,737.94 / $2,041,737.94 / $2,041,737.94
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $199.53 / $346.74
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187,761.62 / $2,187,761.62 / $2,238,721.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454,708.92 / $2,454,708.92 / $3,981,071.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398,832.92 / $2,398,832.92 / $2,511,886.43