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Wisconsin 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
$579,414.32 / $1,140,280.00 / $1,140,280.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $568,163.56 / $618,792.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $562,538.18 / $843,807.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900,061.10 / $1,031,079.00 / $1,031,079.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640,324.35 / $1,161,496.21 / $1,660,283.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531,350.25 / $739,012.47 / $839,786.90
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562,538.18 / $579,414.32 / $787,553.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$473,458.43 / $525,510.42 / $1,012,568.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$984,720.00 / $984,720.00 / $984,720.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562,538.18 / $579,414.32 / $811,180.06
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,538.18 / $562,538.18 / $875,649.06
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$939,176.70 / $939,176.70 / $939,176.70
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$730,876.44 / $950,139.30 / $984,720.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$789,803.62 / $789,803.62 / $789,803.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$516,442.29 / $516,442.29 / $1,110,350.92