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Texas 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 / $190.55 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $151.36 / $151.36
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $512.86
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $275.42
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $190.55
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $275.42 / $602.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $169.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $199.53 / $204.17