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Washington 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
$618,792.00 / $1,083,270.00 / $1,126,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $568,163.56 / $655,379.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$473,853.52 / $939,176.70 / $1,146,725.51
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560,338.55 / $984,720.00 / $984,720.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536,663.75 / $563,231.27 / $674,814.82
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434,918.00 / $562,538.18 / $1,542,522.85
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $562,538.18 / $703,172.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $60.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99,999.00 / $99,999.00 / $99,999.00
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426,468.16 / $724,995.88 / $1,326,789.84
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$545,721.02 / $570,083.56 / $998,864.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$852,129.78 / $852,129.78 / $852,129.78