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Alaska rates for HCPCS M0249

Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.73 / $371.73 / $371.73
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$643.50 / $643.50 / $643.50
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,611.25 / $1,854.90 / $2,545.53
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$643.50 / $643.50 / $643.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.73 / $1,933.50 / $2,945.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$683.94 / $1,052.14 / $1,591.13