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Utah 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
$64,115.90 / $64,115.90 / $64,115.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $55,272.32 / $69,090.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,967.22 / $78,123.89 / $84,352.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $55,272.32 / $55,272.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39,162.17 / $57,017.10 / $74,122.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89,274.87 / $112,135.82 / $160,987.06
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60,799.55 / $74,917.21 / $78,857.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $55,272.32 / $55,272.32