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Alaska rates for HCPCS Q2042

Tisagenlecleucel, up to 600 million CAR-positive viable T cells, including leukapheresis and dose preparation procedures, per therapeutic dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715,352.29 / $3,715,352.29 / $3,715,352.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,341.33 / $562,341.33 / $616,595.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562,341.33 / $676,082.98 / $1,412,537.54
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,341.33 / $676,082.98 / $1,412,537.54
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562,341.33 / $870,963.59 / $870,963.59
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575,439.94 / $575,439.94 / $616,595.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.55 / $616,595.00 / $1,047,128.55
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $616,595.00 / $1,023,292.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616,595.00 / $616,595.00 / $616,595.00