go back

Washington 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
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $302.00 / $302.00
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $194.98 / $208.93
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $331.13 / $446.68