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Ohio 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
$503,500.00 / $1,224,870.00 / $1,673,770.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591,726.19 / $591,726.19 / $615,395.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591,726.19 / $721,905.96 / $1,248,542.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$591,726.19 / $591,726.19 / $893,506.60
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591,726.19 / $591,726.19 / $798,830.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.81 / $518,262.49 / $620,937.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $50.00 / $60.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$591,726.19 / $591,726.19 / $591,726.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,917.26 / $5,917.26 / $5,917.26