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New Hampshire 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 / $454.95 / $540.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $450.01 / $450.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.73 / $371.73 / $371.73
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.11 / $760.10 / $1,494.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$627.74 / $772.61 / $1,581.72
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $495.00 / $630.00