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New Hampshire 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
Facility
Modifier
Low / Median / High Price
$55,946.00 / $55,946.00 / $67,135.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.31 / $55,272.32 / $56,930.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66,078.06 / $99,490.18 / $241,578.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $55,272.32 / $55,272.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52,143.70 / $55,272.32 / $55,272.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $55,272.32 / $55,272.32
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $55,272.32 / $92,619.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $55,272.32 / $60,346.32