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Maryland 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
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.07 / $551.07 / $551.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.10 / $530.62 / $714.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.15 / $586.97 / $895.62
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00