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Ohio 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
$422,940.00 / $1,061,790.00 / $1,629,380.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489,304.61 / $489,304.61 / $587,165.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489,304.61 / $596,951.62 / $1,032,432.72
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489,304.60 / $489,304.60 / $831,817.80
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489,304.61 / $489,304.61 / $660,561.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489,720.00 / $489,720.00 / $586,740.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538,235.07 / $538,235.07 / $538,235.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,893.05 / $89,304.61 / $89,304.61