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Oregon 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
$533,077.00 / $735,165.63 / $1,066,460.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,230.17 / $533,230.17 / $645,023.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508,615.80 / $533,794.80 / $639,546.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.00 / $533,230.17 / $1,119,783.36
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $533,230.17 / $922,488.19
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,230.17 / $629,211.60 / $693,199.22
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $99,999.00 / $99,999.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.66 / $559,891.68 / $978,911.92
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498,750.00 / $587,347.15 / $622,176.30