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South Dakota 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
$489,304.61 / $489,304.61 / $489,304.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489,304.61 / $489,304.61 / $592,561.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462,000.00 / $466,620.00 / $577,500.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489,304.61 / $778,296.38 / $1,231,465.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489,304.61 / $996,400.00 / $996,400.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487,957.01 / $587,278.99 / $732,077.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487,957.01 / $513,869.11 / $514,206.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535,465.42 / $535,465.42 / $535,465.42