go back

Wisconsin 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
$7.08 / $17.38 / $22.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $12.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.13 / $16.22 / $16.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $10.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $7.59 / $18.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.76 / $14.13
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $16.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.41 / $7.59 / $16.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $9.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $14.45 / $25.12
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.61 / $6.76 / $89.13
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.23 / $10.23 / $12.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.41 / $7.59 / $7.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $10.47