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Indiana 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
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$414.84 / $414.84 / $539.29
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.84 / $414.84 / $572.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$594.00 / $594.00 / $594.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.11 / $493.80 / $842.66