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Montana rates for HCPCS Q2043

Sipuleucel-T, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.31 / $55,272.32 / $172,361.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65,085.56 / $65,085.56 / $140,710.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $55,272.32 / $65,085.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32,860.00 / $65,085.56 / $93,631.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $66,018.28 / $70,394.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $55,272.32 / $55,272.32