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Indiana 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
Facility
Modifier
Low / Median / High Price
$191.92 / $387.70 / $387.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.91 / $191.92 / $191.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.89 / $383.84 / $508.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.96 / $161.54 / $229.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.92 / $191.92 / $287.88
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.92 / $191.92 / $239.90
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 / $436.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.35 / $190.24 / $202.02