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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
$190.55 / $190.55 / $371.54
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $194.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $309.03 / $707.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $371.54 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $190.55 / $275.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $181.97 / $194.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $162.18 / $269.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $204.17 / $204.17