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New Hampshire 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
$0.88 / $533,077.00 / $533,077.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453,245.65 / $533,230.17 / $549,227.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $2.29 / $3.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,230.17 / $533,230.17 / $533,230.17
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,230.17 / $533,230.17 / $893,533.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33,230.17 / $33,230.17 / $33,230.17
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $3,000.00 / $3,750.00