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Washington 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 / $288.40 / $457.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $338.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $181.97 / $288.40
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $309.03 / $426.58
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $169.82 / $169.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $223.87 / $426.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $181.97 / $181.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $181.97 / $181.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $190.55 / $204.17
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $257.04 / $363.08