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Maine rates for HCPCS J3399

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

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511,886.43 / $2,570,395.78 / $2,570,395.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691,534.80 / $2,691,534.80 / $2,691,534.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137,962.09 / $2,137,962.09 / $2,570,395.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46,773.51 / $46,773.51 / $46,773.51