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Minnesota 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
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.01 / $165.55 / $191.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.03 / $176.57 / $191.51
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.50 / $150.50 / $150.50
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.50 / $150.53 / $160.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.84 / $184.84 / $184.84