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South Dakota rates for HCPCS M0249

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, first dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $549.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $758.58 / $1,230.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $588.84 / $954.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $676.08 / $954.99