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Indiana rates for HCPCS J3399

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,408.33 / $2,833.33 / $4,023.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,012,188.00 / $3,012,188.00 / $3,681,563.00
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,012,187.50 / $3,012,187.50 / $3,765,234.38