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Wisconsin rates for HCPCS Q0249

Injection Tocilizumab For Hospitalized Adults 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 Extracor- Poreal Membrane Oxygenation (Ecmo) Only 1 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.80 / $7.80 / $22.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.57 / $7.80 / $7.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.00 / $16.28 / $16.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.57 / $7.57 / $10.98
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.36 / $10.36 / $12.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.77 / $7.57 / $18.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.57 / $7.73 / $12.13
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.57 / $7.57 / $16.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.46 / $7.57 / $16.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.57 / $7.57 / $9.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.57 / $16.03 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.57 / $7.57 / $16.39
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.57 / $14.33 / $25.30
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.57 / $6.57 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.77 / $6.77 / $6.77
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.88 / $7.88 / $7.88
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.63 / $10.63 / $10.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.57 / $7.57 / $11.36