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Idaho rates for HCPCS Q2041

Axicabtagene ciloleucel, up to 200 million autologous anti-CD19 CAR positive T cells, including leukapheresis and dose preparation procedures, per therapeutic dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$533,077.00 / $533,077.00 / $613,038.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,077.00 / $549,227.07 / $666,537.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $0.87 / $0.87
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $666,537.71 / $853,168.27
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,230.17 / $639,876.19 / $666,537.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $502,840.72 / $980,539.44