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Nebraska 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
$447.30 / $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
$638.38 / $819.00 / $1,624.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.75 / $652.69 / $897.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$441.00 / $441.00 / $441.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.90 / $441.90 / $552.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$560.79 / $750.50 / $2,384.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$671.20 / $818.03 / $1,098.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.45 / $674.91 / $798.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.45 / $706.52 / $798.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$698.45 / $931.29 / $1,050.44