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Maine 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
$1,237,090.00 / $1,237,090.00 / $1,333,080.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,230.17 / $554,559.38 / $645,023.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.77 / $0.97 / $2.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,230.17 / $533,230.17 / $533,230.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,794.80 / $533,794.80 / $639,546.60
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,230.17 / $533,230.17 / $533,230.17
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,237,090.00 / $1,237,090.00 / $1,333,080.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,230.17 / $559,891.68 / $895,569.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33,230.17 / $33,230.17 / $33,230.17