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Pennsylvania 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
$7.59 / $19.50 / $22.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $8.13
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.92 / $8.13 / $10.23
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $7.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $7.59
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $13.18 / $13.18
Johns Hopkins Employer Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $9.12 / $9.12
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $18.62 / $22.91
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $20.89
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.07 / $6.46 / $8.71
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.07 / $6.46 / $8.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $10.47