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Idaho 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
Facility
Modifier
Low / Median / High Price
$421.20 / $421.20 / $421.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.20 / $450.00 / $450.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $477.00 / $643.50
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$873.97 / $1,222.66 / $1,502.42
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $450.00 / $672.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.81 / $580.04 / $823.39