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Pennsylvania 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
$591,726.19 / $1,526,780.00 / $1,758,110.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591,726.19 / $591,726.19 / $609,477.99
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77,850.02 / $641,967.10 / $802,458.88
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614,055.49 / $614,055.49 / $614,055.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493,816.14 / $518,262.49 / $620,937.13
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.81 / $558,232.27 / $1,004,818.09
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$593,533.00 / $593,533.00 / $1,165,587.14
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$387,653.80 / $1,758,110.00 / $1,758,110.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591,726.19 / $591,726.19 / $670,857.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493,816.14 / $518,262.49 / $620,937.13