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Hawaii 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 / $191.91 / $263.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.55 / $188.55 / $188.55
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.82 / $181.82 / $181.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.92 / $230.30 / $268.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.85 / $202.02 / $252.53