Shoppable Services at Park City Hospital

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
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 1-800 Contacts 1-800 Contacts $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Petersen, Inc. Petersen, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A PEHP PEHP Advantage Care - Non State $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A PEHP PEHP Summit Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A PEHP PEHP Capital Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 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
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 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
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A PEHP PEHP Summit Exclusive $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A PEHP PEHP Advantage Care - Non State $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A PEHP PEHP Summit Exclusive $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A PEHP PEHP Preferred Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A PEHP PEHP Preferred Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A PEHP PEHP Summit Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A PEHP PEHP Capital Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A MotivHealth MotivHealth $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A MotivHealth MotivHealth $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A MotivHealth MotivHealth $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A MotivHealth MotivHealth $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Molina Healthcare of Utah Molina Marketplace $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Molina Healthcare of Utah Molina Healthcare Medicaid HMO $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Molina Healthcare of Utah Molina Marketplace $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Molina Healthcare of Utah Molina CHIP $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Molina Healthcare of Utah Molina Healthcare Medicaid HMO $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Molina Healthcare of Utah Molina CHIP $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A MedCare International, Inc. MedCare International, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A MedCare International, Inc. MedCare International, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 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
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 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
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A LW Miller LW Miller $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A LW Miller LW Miller $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Juniper Systems Juniper Systems $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Juniper Systems Juniper Systems $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Inovar Inovar $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Inovar Inovar $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 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
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 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
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Icon Health Fitness Icon Health Fitness $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Icon Health Fitness Icon Health Fitness $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Hygeia Corporation Hygeia Corporation $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Hygeia Corporation Hygeia Corporation $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Humana Humana ChoiceCare $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Humana Humana ChoiceCare $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Healthy U Healthy U-Medicaid $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Healthy U Healthy U-Medicaid $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A HealthSCOPE Benefits, Inc. HealthSCOPE Benefits, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A HealthSCOPE Benefits, Inc. HealthSCOPE Benefits, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Health Utah Health Utah $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Health Utah Health Utah $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Health Plan of Nevada Medicaid Health Plan of Nevada Medicaid (HPN) $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Health Plan of Nevada Medicaid Health Plan of Nevada Medicaid (HPN) $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Health Choice Utah Health Choice Utah-Medicaid $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Health Choice Utah Health Choice Utah-Medicaid $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Global Excel Global Excel $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Global Excel Global Excel $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 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
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 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
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Franklin County Franklin County $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Franklin County Franklin County $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A EMI Health EMI Health Network Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A EMI Health EMI Health $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A EMI Health EMI Health Choice $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A EMI Health EMI Health Network Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A EMI Health EMI Health $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A EMI Health EMI Health Choice $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Dixie State University Dixie State University $45.00 $40.00 $54.00 $43.20 $45.00 $40.00 $54.00 $43.20 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Dixie State University Dixie State University $45.00 $40.00 $54.00 $43.20 $45.00 $40.00 $54.00 $43.20 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Deseret Mutual DMBA Deseret Select $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Deseret Mutual DMBA Deseret Value $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Deseret Mutual DMBA Deseret Premier $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Deseret Mutual DMBA Deseret Premier $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Big-D Construction Big-D Construction $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Big-D Construction Big-D Construction $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A BYU Risk Management BYU Risk Management $45.00 $40.00 $54.00 $51.00 $45.00 $40.00 $54.00 $51.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A BYU Risk Management BYU Risk Management $45.00 $40.00 $54.00 $51.00 $45.00 $40.00 $54.00 $51.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A BYU Athletic Department BYU Athletic Department $45.00 $40.00 $54.00 $51.00 $45.00 $40.00 $54.00 $51.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A BYU Athletic Department BYU Athletic Department $45.00 $40.00 $54.00 $51.00 $45.00 $40.00 $54.00 $51.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 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
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 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
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 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
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 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
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Altius Altius (Coventry) Limited Facility $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Altius Altius (Coventry) Limited Facility $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Aetna Aetna Utah Connected Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Aetna Aetna Utah Connected Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 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
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 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
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 1-800 Contacts 1-800 Contacts $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Deseret Mutual DMBA Deseret Value $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Deseret Mutual DMBA Deseret Select $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Corporation of the President Corporation of the President $45.00 $40.00 $54.00 $45.00 $45.00 $40.00 $54.00 $45.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Corporation of the President Corporation of the President $45.00 $40.00 $54.00 $45.00 $45.00 $40.00 $54.00 $45.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A CorVel Corporation CorVel Corporation $45.00 $40.00 $54.00 $45.00 $45.00 $40.00 $54.00 $45.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A CorVel Corporation CorVel Corporation $45.00 $40.00 $54.00 $45.00 $45.00 $40.00 $54.00 $45.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Cigna Healthcare CIGNA Utah Connect $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Cigna Healthcare CIGNA Utah Connect $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Cigna Healthcare CIGNA PPO and EPO $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A Cigna Healthcare CIGNA PPO and EPO $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 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
1900005292 23978996 0011A Covid-19 Moderna 1st Vaccine Admin 0011A 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