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New York rates for HCPCS J3399

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,394,480.06 / $2,394,480.06 / $2,394,480.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,254,412.00 / $2,511,290.97 / $2,511,290.97
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,125,000.00 / $2,125,000.00 / $2,337,500.00
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,125,000.00 / $2,125,000.00 / $2,125,000.00
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511,781.25 / $2,511,781.25 / $4,345,381.55
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511,781.25 / $2,511,781.25 / $2,888,548.44
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511,190.52 / $2,661,968.43 / $2,661,968.43
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511,190.52 / $2,661,968.43 / $2,661,968.43
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $74,999.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,455,110.60 / $2,455,110.60 / $2,455,110.60
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511,190.52 / $2,511,190.52 / $2,511,190.52
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511,190.52 / $2,511,190.52 / $2,661,968.43