go back

Kentucky 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
$450.00 / $450.00 / $450.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.60 / $414.84 / $710.28
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.41 / $434.06 / $607.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$517.50 / $517.50 / $517.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,169.00 / $2,169.00 / $2,169.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.15 / $501.60 / $779.46