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Texas 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
$450.00 / $450.00 / $450.00
Cigna
Facility/Professional
Facility
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$793.40 / $2,384.42 / $2,384.42
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $524.88 / $643.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.19 / $425.19 / $437.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $524.88 / $657.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.73 / $425.19 / $630.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.89 / $491.39 / $701.98
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.25 / $450.00 / $609.92