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Kentucky rates for HCPCS M0220

Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known SARS-CoV-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s), includes injection and post administration monitoring

Insurance Carrier
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$202.50 / $202.50 / $202.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.50 / $253.13 / $324.00