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Wisconsin 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
$2,238,721.14 / $2,238,721.14 / $2,238,721.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511,886.43 / $2,511,886.43 / $2,511,886.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318,256.74 / $2,454,708.92 / $3,548,133.89
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398,832.92 / $2,454,708.92 / $2,511,886.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454,708.92 / $2,454,708.92 / $2,454,708.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $85.11
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137,962.09 / $2,137,962.09 / $2,137,962.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570,395.78 / $2,570,395.78 / $2,570,395.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398,832.92 / $2,398,832.92 / $2,398,832.92