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New Hampshire 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 / $0.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511,886.43 / $2,570,395.78 / $2,951,209.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137,962.09 / $3,548,133.89 / $4,073,802.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,022.64 / $46,773.51 / $93,325.43