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Michigan 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 / $191.92 / $191.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.91 / $191.92 / $211.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.26 / $367.96 / $696.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.93 / $168.35 / $168.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.92 / $191.92 / $191.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.55 / $188.55 / $191.92
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.19 / $191.92 / $287.88
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.19 / $177.84 / $199.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.35 / $202.02 / $208.13