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New Hampshire 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 / $1,083,270.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478,157.46 / $562,538.18 / $579,414.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $562,538.18 / $562,538.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $562,538.18 / $942,645.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62,538.19 / $62,538.19 / $62,538.19