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South Dakota 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 / $533,230.17 / $533,230.17
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
$503,580.00 / $508,615.80 / $629,475.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $759,387.73 / $1,231,196.67
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,230.17 / $957,600.00 / $957,600.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487,957.01 / $603,408.87 / $734,275.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487,957.01 / $527,982.76 / $559,730.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583,534.90 / $583,534.90 / $583,534.90