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Utah 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
$618,547.00 / $618,547.00 / $618,547.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,230.17 / $533,230.17 / $639,876.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533,794.80 / $533,794.80 / $639,546.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $60.00 / $60.00