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Michigan rates for HCPCS Q0249

Injection, 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, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.80 / $7.80 / $24.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.57 / $7.80 / $9.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.57 / $7.57 / $7.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.77 / $6.77 / $7.57
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.04 / $9.75 / $21.70
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.04 / $7.64 / $8.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.57 / $7.57 / $9.86