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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A SelectHealth SelectHealth Community Care-Medicaid $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A SelectHealth SelectHealth Care Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A SelectHealth SelectHealth Share Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A SelectHealth SelectHealth Share Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A SelectHealth SelectHealth Value Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A SelectHealth SelectHealth Value Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A SelectHealth SelectHealth Community Care-Medicaid $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A SelectHealth SelectHealth Care Network $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A Petersen, Inc. Petersen, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A Petersen, Inc. Petersen, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A 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
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A PEHP PEHP Summit Exclusive $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A PEHP PEHP Advantage Care - Non State $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900005299 23980995 0012A Covid-19 Moderna 2nd Vaccine Admin 0012A PEHP PEHP Advantage Care - Non State $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Petersen, Inc. Petersen, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Petersen, Inc. Petersen, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A PEHP PEHP Advantage Care - Non State $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A PEHP PEHP Advantage Care - Non State $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A PEHP PEHP Capital Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A PEHP PEHP Capital Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A PEHP PEHP Summit Exclusive $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A PEHP PEHP Preferred Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A PEHP PEHP Preferred Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A PEHP PEHP Summit Exclusive $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A PEHP PEHP Summit Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A PEHP PEHP Summit Care $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A MotivHealth MotivHealth $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A MotivHealth MotivHealth $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A MotivHealth MotivHealth $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A MotivHealth MotivHealth $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Molina Healthcare of Utah Molina CHIP $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Molina Healthcare of Utah Molina Marketplace $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Molina Healthcare of Utah Molina CHIP $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Molina Healthcare of Utah Molina Marketplace $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A MedCare International, Inc. MedCare International, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A MedCare International, Inc. MedCare International, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A LW Miller LW Miller $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A LW Miller LW Miller $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Juniper Systems Juniper Systems $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Juniper Systems Juniper Systems $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Inovar Inovar $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Inovar Inovar $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Icon Health Fitness Icon Health Fitness $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Icon Health Fitness Icon Health Fitness $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Hygeia Corporation Hygeia Corporation $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Hygeia Corporation Hygeia Corporation $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Humana Humana ChoiceCare $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Humana Humana ChoiceCare $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Healthy U Healthy U-Medicaid $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Healthy U Healthy U-Medicaid $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A HealthSCOPE Benefits, Inc. HealthSCOPE Benefits, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A HealthSCOPE Benefits, Inc. HealthSCOPE Benefits, Inc. $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Health Utah Health Utah $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A Health Utah Health Utah $45.00 $40.00 $54.00 $40.00 $45.00 $40.00 $54.00 $40.00 $60.00
1900008136 24517287 0031A Covid-19 Janssen Single Dose Vaccine Admin 0031A 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