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Arizona rates for HCPCS 91304

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.91 / $191.92 / $263.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.22 / $432.01 / $913.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.50 / $156.37 / $1,220.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.55 / $188.55 / $188.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.55 / $188.55 / $188.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.54 / $191.92 / $274.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.04 / $182.54 / $193.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.24 / $202.02 / $202.02