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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
$616,595.00 / $616,595.00 / $616,595.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537,031.80 / $537,031.80 / $660,693.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512,861.38 / $537,031.80 / $645,654.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $60.26
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407,380.28 / $489,778.82 / $549,540.87
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478,630.09 / $537,031.80 / $645,654.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426,579.52 / $501,187.23 / $537,031.80