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South Dakota 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
$562,538.18 / $562,538.18 / $562,538.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $562,538.18 / $655,379.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531,350.25 / $536,663.75 / $664,187.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562,538.18 / $871,934.19 / $1,297,276.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $984,720.00 / $984,720.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514,462.76 / $619,730.74 / $774,728.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514,462.76 / $542,264.40 / $568,717.43
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615,607.81 / $615,607.81 / $615,607.81