go back

West Virginia 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
$299.57 / $299.57 / $450.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.48 / $400.48 / $600.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$517.50 / $517.50 / $517.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.73 / $371.73 / $2,169.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.83 / $531.23 / $782.87