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Pennsylvania 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
$533,230.17 / $1,407,320.00 / $1,620,550.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,230.17 / $533,230.17 / $554,559.38
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77,850.02 / $578,504.43 / $723,130.54
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553,352.06 / $553,352.06 / $553,352.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508,615.80 / $533,794.80 / $639,546.60
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.17 / $1.38 / $791,041.93
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$517,669.24 / $1,620,550.00 / $1,620,550.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,230.17 / $533,230.17 / $645,023.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639,876.21 / $789,180.65 / $1,066,460.34
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508,615.80 / $533,794.80 / $639,546.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33,230.17 / $33,230.17 / $33,230.17