go back

New Hampshire rates for HCPCS Q2055

Idecabtagene vicleucel, up to 510 million autologous B-cell maturation antigen (BCMA) directed CAR-positive T cells, including leukapheresis and dose preparation procedures, per therapeutic dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$541,260.00 / $541,260.00 / $1,082,520.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557,317.93 / $557,317.93 / $557,317.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.04 / $0.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557,317.93 / $557,317.93 / $557,317.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$584,737.97 / $905,084.32 / $1,720,161.79