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Wisconsin rates for HCPCS 0034A

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage; booster dose

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $112.20 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $50.12 / $102.33
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $104.71
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $245.47 / $245.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $85.11