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Michigan 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
$480,796.00 / $549,227.07 / $1,066,150.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480,796.00 / $533,230.17 / $581,220.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68,270.08 / $735,344.52 / $1,993,715.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746,522.24 / $746,522.24 / $746,522.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508,615.80 / $558,973.80 / $639,546.60
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$518,687.40 / $604,296.00 / $1,287,800.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480,796.00 / $533,230.17 / $639,876.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502,840.73 / $553,124.80 / $719,653.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.64 / $224.64 / $224.64