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Wisconsin 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
$575,439.94 / $831,763.77 / $1,659,586.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,341.33 / $562,341.33 / $912,010.84
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
$562,341.33 / $562,341.33 / $707,945.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660,693.45 / $1,202,264.43 / $1,778,279.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524,807.46 / $707,945.78 / $1,023,292.99
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562,341.33 / $562,341.33 / $562,341.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478,630.09 / $537,031.80 / $707,945.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $50.12 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562,341.33 / $562,341.33 / $870,963.59
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562,341.33 / $1,000,000.00 / $1,000,000.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758,577.58 / $758,577.58 / $933,254.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524,807.46 / $524,807.46 / $562,341.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524,807.46 / $524,807.46 / $524,807.46