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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
$63,095.73 / $63,095.73 / $63,095.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54,954.09 / $54,954.09 / $67,608.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,565.42 / $81,283.05 / $85,113.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54,954.09 / $54,954.09 / $56,234.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38,018.94 / $54,954.09 / $72,443.60
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89,125.09 / $112,201.85 / $199,526.23
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54,954.09 / $60,255.96 / $79,432.82
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47,863.01 / $56,234.13 / $58,884.37
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50,118.72 / $54,954.09 / $66,069.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54,954.09 / $54,954.09 / $54,954.09