Shoppable Services at Intermountain Medical Center

General Disclosure

The two lists of standard charges displayed represent the pricing information for medical items and services required by the federal Hospital Price Transparency Rule. The pricing information does not necessarily reflect your financial responsibility for your hospital visit, for several reasons, including:

  • The listings reflect prices paid by your insurer for services provided during your hospital visit, which may not reflect your share of the costs for these services under the terms of your health plan.
  • The prices for your insurer are only available if your insurer covers the medical items or services under the terms of your health plan.
  • The actual medical items, including medications, and services that are furnished to you during your visit may vary from what is anticipated.
  • You may receive services or supplies from physicians, practitioners or contractors who are not employed by this hospital; the prices for such services or supplies are not listed here.
  • Your insurer may not be contracted with this hospital for all services. The posted prices will not apply to services for which your insurer has not contracted.

These listings do not guarantee pricing, coverage, benefits, or payments. Your financial liability will be based on the medical items and services billed by the hospital, the terms of your insurance policy, and the status of your benefits (i.e., deductibles, out of pocket maximum, co-insurance, and copays) at the time you receive care. Your eligibility and the amounts covered by your insurance are solely determined by your health insurance provider.

We encourage you to contact a Hospital Cost Estimation Specialist at (855) 442-8601 or INTCostEstimate@R1RCM.com or your insurer to obtain more precise information regarding your potential financial liability.

CDM Bill Item Service Code Service Description Payer Plan Name Inpatient Cash Price Inpatient Min Price Inpatient Max Price Inpatient Negotiated Price Outpatient Cash Price Outpatient Min Price Outpatient Max Price Outpatient Negotiated Price Charge Price
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A 1-800 Contacts 1-800 Contacts $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Aetna Aetna Utah Connected Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Aetna Aetna Standard Network AKA Aetna Health Plan Network for Utah $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Altius Altius (Coventry) Limited Facility $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A BCBS OOS - PPO BCBS Association-Blue Card PPO Plan $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A BCBS OOS -TRAD BCBS Association-Blue Card Traditional Plan $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A BYU Risk Management BYU Risk Management $45.00 $40.00 $54.00 $42.00 $45.00 $40.00 $54.00 $43.80 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Big-D Construction Big-D Construction $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A CCCM CCCM $45.00 $40.00 $54.00 $53.40 $45.00 $40.00 $54.00 $53.40 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Campbell Scientific Campbell Scientific $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Cigna Healthcare CIGNA Managed Care (HMO or Open Access Plus aka OAP) $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Cigna Healthcare CIGNA PPO and EPO $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Cigna Healthcare CIGNA Utah Connect $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A CorVel Corporation CorVel Corporation $45.00 $40.00 $54.00 $43.20 $45.00 $40.00 $54.00 $43.20 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Corporation of the President Corporation of the President $45.00 $40.00 $54.00 $42.00 $45.00 $40.00 $54.00 $43.80 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Deseret Mutual DMBA Deseret Select $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Deseret Mutual DMBA Deseret Value $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Deseret Mutual DMBA Deseret Premier $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Dixie State University Dixie State University $45.00 $40.00 $54.00 $43.20 $45.00 $40.00 $54.00 $43.20 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A EMI Health EMI Health Network Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A EMI Health EMI Health Choice $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A EMI Health EMI Health $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Franklin County Franklin County $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Franklin County Medical Center Franklin County Medical Center $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Global Excel Global Excel $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Health Utah Health Utah $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A HealthSCOPE Benefits, Inc. HealthSCOPE Benefits, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Humana Humana ChoiceCare $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Hygeia Corporation Hygeia Corporation $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Icon Health Fitness Icon Health Fitness $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Injury Care of Nevada Injury Care of Nevada $45.00 $40.00 $54.00 $45.00 $45.00 $40.00 $54.00 $45.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Inovar Inovar $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Juniper Systems Juniper Systems $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A LW Miller LW Miller $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Managed Care Administrators, Inc. Managed Care Administrators, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A MedCare International, Inc. MedCare International, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Molina Healthcare of Utah Molina Marketplace $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Molina Healthcare of Utah Molina CHIP $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A MotivHealth MotivHealth $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A MotivHealth MotivHealth $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A PEHP PEHP Capital Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A PEHP PEHP Advantage Care State Employees and Advantage Care Exclusive $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A PEHP PEHP Summit Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A PEHP PEHP Summit Exclusive $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A PEHP PEHP Advantage Care - Non State $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A PEHP PEHP Preferred Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Petersen, Inc. Petersen, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Prodegi Corporate Benefit Services, LLC Prodegi Corporate Benefit Services, LLC $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Provider Networks of America Provider Networks of America (PNOA) $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Regence BlueCross BlueShield of Utah Regence Focal Point $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Regence BlueCross BlueShield of Utah Regence Individual and Family Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Regence BlueCross BlueShield of Utah Regence BCBS Federal (FEHBP) $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Regence BlueCross BlueShield of Utah Regence BCBS Traditional Plan $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Regence BlueCross BlueShield of Utah Regence BCBS ValueCare $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Regence BlueCross BlueShield of Utah Regence BCBS Preferred BlueOption (PBO) $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Regence BlueCross BlueShield of Utah Regence Bridgespan RealValue $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A SelectHealth SelectHealth Value Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A SelectHealth SelectHealth Med Network Individual Plan (ACA) $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A SelectHealth SelectHealth Med Network CHIP $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A SelectHealth SelectHealth Med Network Federal Employee (FEHBP) $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A SelectHealth SelectHealth Value Network Individual Plan (ACA) $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A SelectHealth SelectHealth Med Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A SelectHealth SelectHealth Share Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A SelectHealth SelectHealth Care Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Sinclair Services Company Sinclair Services Company $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A SpringTide SpringTide $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Tanner LLC Tanner LLC $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Union Pacific Railroad Employes Health Union Pacific Railroad Employes Health $45.00 $40.00 $54.00 $54.00 $45.00 $40.00 $54.00 $54.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A United Healthcare United Healthcare Options PPO $45.00 $40.00 $54.00 $51.00 $45.00 $40.00 $54.00 $51.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A United Healthcare United Healthcare Choice Plus Network $45.00 $40.00 $54.00 $42.60 $45.00 $40.00 $54.00 $42.60 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A University of Utah University of Utah Healthy Preferred - Marketplace $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A University of Utah University of Utah Healthy Preferred $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A University of Utah University of Utah Healthy Premier $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A University of Utah University of Utah Healthy Premier - Marketplace $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Utah Cancer Control Program (UCCP) Utah Cancer Control Program (UCCP) $45.00 $40.00 $54.00 $0.00 $45.00 $40.00 $54.00 $0.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A WCF Insurance WCF Insurance $45.00 $40.00 $54.00 $42.00 $45.00 $40.00 $54.00 $43.80 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Wise Wise Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005278 23975023 0001A Covid-19 Pfizer 1st Dose Vaccine Admin 0001A Wise Wise Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se 1-800 Contacts 1-800 Contacts $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se 1-800 Contacts 1-800 Contacts $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se Aetna Aetna Standard Network AKA Aetna Health Plan Network for Utah $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se Aetna Aetna Standard Network AKA Aetna Health Plan Network for Utah $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se Aetna Aetna Utah Connected Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se Aetna Aetna Utah Connected Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se Altius Altius (Coventry) Limited Facility $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se Altius Altius (Coventry) Limited Facility $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se BCBS OOS - PPO BCBS Association-Blue Card PPO Plan $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se BCBS OOS - PPO BCBS Association-Blue Card PPO Plan $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se BCBS OOS -TRAD BCBS Association-Blue Card Traditional Plan $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se BCBS OOS -TRAD BCBS Association-Blue Card Traditional Plan $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se BYU Risk Management BYU Risk Management $45.00 $40.00 $54.00 $42.00 $45.00 $40.00 $54.00 $43.80 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se BYU Risk Management BYU Risk Management $45.00 $40.00 $54.00 $42.00 $45.00 $40.00 $54.00 $43.80 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se Big-D Construction Big-D Construction $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se Big-D Construction Big-D Construction $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se CCCM CCCM $45.00 $40.00 $54.00 $53.40 $45.00 $40.00 $54.00 $53.40 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se CCCM CCCM $45.00 $40.00 $54.00 $53.40 $45.00 $40.00 $54.00 $53.40 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se Campbell Scientific Campbell Scientific $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se Campbell Scientific Campbell Scientific $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
0012A 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A / Immunization administration by intramuscular injection of se Cigna Healthcare CIGNA PPO and EPO $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00