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Idaho 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
$578,325.00 / $578,325.00 / $665,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578,325.00 / $597,643.46 / $739,657.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.81 / $2.81 / $2.81
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.31 / $739,657.75 / $946,761.92
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591,726.19 / $710,071.44 / $739,657.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $897,095.25 / $1,128,603.60