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Washington 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
$60,799.56 / $111,892.00 / $116,927.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.31 / $55,825.05 / $60,799.56
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53,426.66 / $83,269.17 / $285,085.50
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $55,945.97 / $245,198.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52,143.70 / $52,143.70 / $55,536.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $55,272.32 / $67,786.81
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45,936.48 / $55,272.32 / $153,793.97
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,591.80 / $55,272.32 / $70,361.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $70.00 / $80.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55,272.32 / $63,335.06 / $99,999.00
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48,083.99 / $85,482.65 / $149,594.64
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60,251.86 / $65,491.15 / $107,405.49
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53,062.44 / $66,615.34 / $123,599.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52,508.70 / $55,272.32 / $57,483.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $55,272.32 / $66,326.78
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $55,272.32 / $55,536.50