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Idaho 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
$541,636.00 / $541,636.00 / $622,881.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$541,636.00 / $579,414.32 / $703,172.73
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562,538.18 / $703,172.73 / $984,441.83
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $675,045.83 / $703,172.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $800,485.56 / $1,007,062.50