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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
$450.00 / $450.00 / $450.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.00 / $514.88 / $728.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.00 / $450.29 / $717.39
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$439.65 / $495.00 / $1,073.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$412.74 / $464.31 / $647.67