go back

Wisconsin 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
$56,930.49 / $56,930.49 / $56,930.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.31 / $55,272.32 / $60,799.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102,253.79 / $118,835.49 / $123,257.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $55,272.32 / $82,908.48
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81,803.03 / $88,435.71 / $101,308.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55,272.32 / $83,645.00 / $153,062.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $66,721.08 / $94,685.40
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51,939.10 / $55,945.97 / $66,326.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,374.20 / $55,945.97 / $69,932.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,945.97 / $62,279.61 / $245,198.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.40 / $85.00 / $55,945.97
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39,164.32 / $55,945.97 / $66,326.78
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $70,553.70 / $171,692.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55,272.32 / $66,147.00 / $285,085.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $102,166.19 / $245,198.88
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53,270.37 / $77,602.34 / $77,602.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,272.32 / $58,035.94 / $66,326.78