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Wisconsin rates for HCPCS 91303

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, for intramuscular use

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.09 / $0.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.09
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $90.00 / $90.00