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Oklahoma 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
Professional
Modifier
Low / Median / High Price
$371.73 / $371.73 / $371.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.00 / $495.00 / $2,384.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.15 / $487.77 / $683.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.15 / $510.99 / $833.99