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South Carolina 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
$446.68 / $602.56 / $602.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $524.81 / $794.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $457.09 / $602.56
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $489.78 / $1,230.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $2,137.96 / $2,818.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $489.78 / $676.08