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Wisconsin 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
$549,540.87 / $794,328.23 / $1,584,893.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537,031.80 / $537,031.80 / $602,559.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537,031.80 / $537,031.80 / $676,082.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602,559.59 / $1,122,018.45 / $1,621,810.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501,187.23 / $870,963.59 / $977,237.22
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537,031.80 / $549,540.87 / $724,435.96
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537,031.80 / $537,031.80 / $537,031.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $457,088.19 / $676,082.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954,992.59 / $954,992.59 / $954,992.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $64.57 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537,031.80 / $537,031.80 / $831,763.77
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537,031.80 / $537,031.80 / $1,000,000.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891,250.94 / $1,995,262.31 / $1,995,262.31
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724,435.96 / $724,435.96 / $891,250.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501,187.23 / $501,187.23 / $537,031.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501,187.23 / $524,807.46 / $562,341.33