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Maine 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
$1,372,800.00 / $1,372,800.00 / $1,479,320.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591,726.19 / $615,395.25 / $621,312.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591,726.19 / $591,726.19 / $591,726.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$518,262.49 / $518,262.49 / $620,937.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591,726.19 / $591,726.19 / $591,726.19
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,372,800.00 / $1,372,800.00 / $1,479,320.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591,726.19 / $615,395.25 / $621,312.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91,726.20 / $91,726.20 / $91,726.20