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Connecticut rates for HCPCS M0250

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, second 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 / $530.23
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.90 / $477.90 / $477.90
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.90 / $477.90 / $477.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.00 / $705.81 / $1,272.67