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Maine 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
$1,305,090.00 / $1,305,090.00 / $1,406,350.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $585,039.71 / $655,379.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $562,538.18 / $562,538.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563,231.27 / $563,231.27 / $674,814.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $562,538.18 / $562,538.18
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,305,090.00 / $1,305,090.00 / $1,406,350.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $590,665.09 / $909,948.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62,538.19 / $62,538.19 / $62,538.19