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Maine 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
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.72 / $233.13 / $608.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.72 / $171.72 / $188.89
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.92 / $222.05 / $340.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.91 / $191.92 / $277.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.35 / $168.35 / $252.53