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North Dakota 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
Professional
Modifier
Low / Median / High Price
$784.89 / $926.63 / $939.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$441.00 / $441.00 / $507.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.00 / $441.90 / $552.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $661.50 / $1,350.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.19 / $824.80 / $993.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.04 / $824.80 / $993.21