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Montana rates for HCPCS M0250

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, second dose

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$710.88 / $710.88 / $710.88
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$710.88 / $710.88 / $710.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.55 / $595.79 / $982.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.27 / $734.74 / $824.95