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Nebraska 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
$190.55 / $194.98 / $426.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $190.55 / $407.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $218.78 / $295.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $208.93 / $218.78
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 / $194.98 / $245.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $169.82 / $588.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $177.83 / $194.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $251.19 / $251.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $177.83 / $323.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $186.21 / $204.17