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Maine 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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.45 / $510.76 / $783.53
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.45 / $614.08 / $794.06