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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
$537,031.80 / $645,654.23 / $1,071,519.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537,031.80 / $537,031.80 / $588,843.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537,031.80 / $537,031.80 / $537,031.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537,031.80 / $537,031.80 / $575,439.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32,359.37 / $32,359.37 / $64,565.42