The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 91304. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
- Full-schedule CSV export
- Full state Medicaid dental network lists
- Email alerts when a state changes its rates
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Publishing states
33
Median % of Medicare
--
Rate range
$15.00 - $191.92
91304 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $191.92 | -- | -- | 2026 |
| Arkansas | $148.20 | -- | -- | 2026 |
| Arizona | $191.92 | -- | -- | 2026 |
| California | $191.92 | -- | -- | 2026 |
| Connecticut | $148.20 | -- | -- | 2026 |
| District of Columbia | $191.92 | -- | Not required | 2026 |
| Delaware | $15.00 | -- | -- | 2026 |
| Florida | $141.70* | -- | -- | 2025 |
| Iowa | $170.58 | -- | -- | 2025 |
| Idaho | $165.82 | -- | Not required | 2026 |
| Indiana | $176.77 | -- | -- | 2025 |
| Kansas | $191.92 | -- | -- | 2025 |
| Kentucky | $161.54 | -- | -- | 2026 |
| Louisiana | $161.54 | -- | -- | 2026 |
| Maryland | $191.92 | -- | -- | 2026 |
| Maine | $191.92 | -- | -- | 2026 |
| Michigan | $191.92 | -- | -- | 2026 |
| Minnesota | $191.91 | -- | -- | 2025 |
| Montana | $191.92 | -- | -- | 2026 |
| North Carolina | $145.95 | -- | -- | 2025 |
| North Dakota | $191.92 | -- | Not required | 2026 |
| Nebraska | $191.91 | -- | -- | 2026 |
| New Hampshire | $141.70 | -- | Not required | 2026 |
| New Jersey | $153.54 | -- | Not required | 2026 |
| New Mexico | $161.54 | -- | -- | 2025 |
| Oklahoma | $179.69 | -- | -- | 2026 |
| Pennsylvania | $40.00 | -- | -- | 2023 |
| South Carolina | $165.66 | -- | -- | 2025 |
| Utah | $191.92* | -- | Not required | 2025 |
| Virginia | $191.91 | -- | -- | 2025 |
| Vermont | $182.32 | -- | -- | 2026 |
| Washington | $191.92 | -- | -- | 2026 |
| Wisconsin | $191.92 | -- | -- | 2025 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * are representative published variants or methodology-derived rates. "--" in the prior-auth column means the state publishes no PA flag.
Related physician codes
- 10004 - Needle biopsy without imaging, each added lesion
- 10005 - Needle biopsy with ultrasound guidance, first lesion
- 10006 - Needle biopsy with ultrasound guidance, each added lesion
- 10007 - Needle biopsy with fluoroscopic guidance, first lesion
- 10009 - Needle biopsy with CT guidance, first lesion
- 10011 - Needle biopsy with MRI guidance, first lesion
- 10012 - Needle biopsy with MRI guidance, each added lesion
- 10021 - Fine needle aspiration biopsy, first lesion, no imaging
Frequently asked questions
How much does Medicaid pay for 91304?
33 state Medicaid programs publish a fee-for-service rate for 91304 (cOVID-19 vaccine, Novavax, 5 mcg dose), ranging from $15.00 in Delaware to $191.92 in Alabama. The full table on this page lists every publishing state's current rate.
Which state pays the most for 91304?
Alabama publishes the highest Medicaid rate for 91304 at $191.92. Delaware publishes the lowest at $15.00.
Does 91304 require prior authorization under Medicaid?
No publishing state flags 91304 with a prior-authorization indicator on its fee schedule. Absence of a flag means the state publishes none, not that PA is never required - confirm through the state's provider manual.