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Illinois rates for HCPCS M0221

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 in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the COVID-19 public health emergency

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,995.26 / $3,890.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $251.19 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $263.03 / $389.05