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Pennsylvania 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
$343,917.56 / $1,429,920.00 / $1,646,570.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $562,538.18 / $585,039.71
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77,850.02 / $610,300.86 / $762,876.08
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583,766.04 / $583,766.04 / $583,766.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536,663.75 / $563,231.27 / $674,814.82
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478,157.46 / $562,538.18 / $834,520.09
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,065,431.59 / $1,065,431.59 / $1,065,431.59
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$315,520.70 / $1,646,570.00 / $1,646,570.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $562,538.18 / $655,379.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675,045.82 / $832,556.51 / $1,125,076.37
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536,663.75 / $563,231.27 / $674,814.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62,538.19 / $62,538.19 / $62,538.19