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Pennsylvania 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
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.83 / $477.18 / $477.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.73 / $371.73 / $371.73
Johns Hopkins Employer Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.33 / $536.33 / $536.33
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.73 / $371.73 / $371.73
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.15 / $424.15 / $424.15
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.15 / $424.15 / $424.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.14 / $547.54 / $861.31