go back

New Hampshire 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
$190.55 / $190.55 / $190.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $501.19 / $831.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $173.78 / $194.98
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 / $190.55 / $190.55
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $316.23 / $363.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $190.55 / $204.17