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Wisconsin 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

Facilitymedian $191 · 10th–90th $162$4270%20%40%10th90th$191Professionalmedian $191 · 10th–90th $174$3470%20%40%10th90th$191$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $281.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$354.81 / $416.87 / $426.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $173.78 / $257.04
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $208.93 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $194.98 / $354.81
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $426.58
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $162.18 / $354.81
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $169.82 / $257.04
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $190.55
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $158.49 / $158.49
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $407.38 / $630.96
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $190.55 / $512.86
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $190.55
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $316.23
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $380.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $190.55 / $275.42