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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
$7.08 / $7.08 / $9.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,565.42 / $83,176.38 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.71 / $8.71 / $8.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $8.71
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.61 / $6.61 / $6.61
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.61 / $6.61 / $6.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.71 / $8.71 / $8.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $8.13 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $7.59