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Ohio 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
$1,000,000.00 / $1,000,000.00 / $1,000,000.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,511,886.43 / $5,248,074.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778,279.41 / $1,778,279.41 / $2,344,228.82
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778,279.41 / $1,778,279.41 / $2,344,228.82
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090,295.43 / $3,090,295.43 / $3,090,295.43
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000,000.00 / $1,000,000.00 / $1,000,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454,708.92 / $2,570,395.78 / $2,570,395.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25,703.96 / $2,398,832.92 / $2,454,708.92