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Ohio 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
$424,000.00 / $1,103,790.00 / $1,548,090.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,230.17 / $533,230.17 / $639,876.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $1.31 / $2.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $1.17 / $693,199.22
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$533,230.19 / $533,230.19 / $805,177.60
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,230.17 / $533,230.17 / $719,860.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $533,794.80 / $639,546.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,230.17 / $639,876.20 / $768,971.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,332.30 / $5,332.30 / $5,332.30