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Illinois 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
$426.58 / $446.68 / $691.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $758.58 / $6,025.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $371.54
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $199.53 / $707.95
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $467.74 / $1,174.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $588.84 / $954.99