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Montana 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
Professional
Modifier
Low / Median / High Price
$7.64 / $9.16 / $9.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.64 / $8.64 / $8.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.77 / $6.77 / $8.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.64 / $8.64 / $8.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.77 / $8.21 / $10.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.57 / $7.57 / $7.57