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Idaho rates for HCPCS Q2053

Brexucabtagene autoleucel, up to 200 million autologous anti-CD19 CAR positive viable T cells, including leukapheresis and dose preparation procedures, per therapeutic dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489,720.00 / $489,720.00 / $563,178.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489,304.61 / $503,983.75 / $611,630.76
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489,304.61 / $611,630.76 / $856,283.07
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489,304.61 / $587,165.53 / $611,630.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $489,399.16 / $954,328.40