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Minnesota 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
$450.00 / $450.00 / $450.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.25 / $962.94 / $1,852.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.00 / $450.00 / $450.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$445.41 / $485.10 / $560.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.32 / $528.00 / $561.21
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$441.00 / $441.00 / $441.00
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.00 / $441.90 / $480.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.76 / $817.52 / $1,490.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.58 / $860.42 / $1,642.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.50 / $860.60 / $1,698.35