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Wisconsin 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
$609,477.99 / $1,167,170.00 / $1,167,170.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591,726.19 / $597,643.46 / $650,898.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591,726.19 / $591,726.19 / $887,589.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$946,761.90 / $1,084,578.00 / $1,084,578.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$600,213.36 / $1,088,738.14 / $1,556,280.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488,926.88 / $797,058.45 / $905,748.24
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.31 / $591,726.19 / $650,898.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.31 / $499,162.19 / $678,472.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998,477.40 / $998,477.40 / $998,477.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $1,412,201.50
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.31 / $597,643.46 / $654,335.56
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591,726.19 / $591,726.21 / $921,083.25
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977,812.60 / $977,812.60 / $977,812.60
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800,411.30 / $940,180.56 / $998,477.40
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$830,783.58 / $830,783.58 / $830,783.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$591,726.19 / $591,726.19 / $591,726.19