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Washington 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
$538,235.06 / $978,609.00 / $1,018,620.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489,304.61 / $494,197.65 / $592,561.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$449,440.00 / $890,400.00 / $1,087,644.80
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507,768.93 / $996,400.00 / $996,400.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466,620.00 / $489,720.00 / $586,740.00
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$422,940.00 / $489,304.61 / $802,459.56
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489,304.61 / $489,304.61 / $611,630.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99,999.00 / $99,999.00 / $99,999.00
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404,496.00 / $697,625.99 / $1,258,432.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515,677.07 / $538,698.36 / $943,873.20