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South Dakota rates for HCPCS Q0249

Injection, 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, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $7.08 / $15.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $12.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $7.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $7.76 / $9.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $12.88 / $20.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $7.59 / $7.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $9.12 / $9.12
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $8.32
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $7.59