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Montana 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 / $211.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.39 / $184.39 / $184.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.39 / $188.55 / $188.55
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.39 / $184.39 / $184.39
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.55 / $208.22 / $271.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.24 / $190.24 / $202.02