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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
$446.68 / $446.68 / $446.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $831.76 / $1,122.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $645.65 / $870.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $549.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $758.58 / $2,398.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $812.83 / $1,096.48
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $1,047.13 / $1,047.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $549.54 / $741.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $870.96 / $1,096.48