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Virginia rates for HCPCS M0249

Intravenous infusion, 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, includes infusion and post administration monitoring, first dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.73 / $371.73 / $371.73
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.41 / $631.69 / $655.34
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$442.80 / $442.80 / $685.35
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$317.82 / $548.04 / $9,929.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.82 / $553.39 / $9,929.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.14 / $629.01 / $956.03