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Idaho 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 / $208.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $147.91 / $239.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $190.55 / $309.03
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $239.88 / $239.88
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $208.93 / $239.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $338.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $229.09
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $204.17 / $204.17