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Ohio 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
$557,917.92 / $1,220,710.00 / $1,634,340.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $562,538.18 / $655,379.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $686,296.59 / $1,186,955.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562,538.19 / $562,538.19 / $849,432.70
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $562,538.18 / $759,426.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563,231.27 / $563,231.27 / $674,814.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $50.00 / $60.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630,059.59 / $630,059.59 / $630,059.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,625.38 / $5,625.38 / $5,625.38