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Arizona rates for HCPCS Q2054

Lisocabtagene maraleucel, up to 110 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
$601,916.00 / $916,125.00 / $1,687,610.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $562,538.18 / $655,379.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.80 / $2.99 / $5.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.80 / $0.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536,663.75 / $589,798.78 / $739,012.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$525,973.21 / $618,244.03 / $1,102,574.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$984,720.00 / $984,720.00 / $984,720.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$516,442.29 / $516,442.29 / $852,129.78