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New Hampshire 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
$7.59 / $9.12 / $15.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.23 / $19.95 / $33.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $11.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $12.59 / $14.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $11.48