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New Hampshire 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
$2.81 / $578,325.00 / $578,325.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502,967.27 / $591,726.19 / $609,477.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.04 / $0.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591,726.19 / $591,726.19 / $591,726.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591,726.19 / $591,726.19 / $991,555.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21,312.51 / $91,726.20 / $91,726.20
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.81 / $3.09 / $3.93