CMS Price Transparency Data
Flu vaccine (high dose)
Facility: Intermountain Health Sanpete Valley Hospital
Billing Code: 90656 (HCPCS)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 90656
- Insurance Median: $38
- Cash Discount Price: $30
- vs. Medicare Baseline: N/A Medicare
The contracted insurance negotiated median rate for a Flu vaccine (high dose) at Intermountain Health Sanpete Valley Hospital is $38. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $30. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1100 South Medical Drive, Mount Pleasant, UT.
Cash / Self-Pay
$30
Average discount available for prompt cash payment at this facility.
Insurance Median
$38
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
N/A
Standard federal government reimbursement rate for this code.
Out-of-Pocket Cost Estimator
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Health Plan of Nevada | $11 - $70 | N/A |
| Selecthealth | $11 - $75 | N/A |
| Molina | $11 - $75 | N/A |
| American Health | $12 - $24 | N/A |
| Health Partners of Nevada | $12 - $24 | N/A |
| UnitedHealthcare | $12 - $75 | N/A |
| Healthy U | $12 - $70 | N/A |
| Triwest | $12 - $71 | N/A |
| Aetna | $12 - $76 | N/A |
| Humana | $12 - $75 | N/A |
| Blue Cross Blue Shield | $12 - $75 | N/A |
| Injury Care of Nevada | $30 - $59 | N/A |
| Byu Risk Management | $34 - $67 | N/A |
| Wcf Insurance | $34 - $67 | N/A |
| Corporation of the President | $34 - $67 | N/A |
| Corvel Corporation | $34 - $67 | N/A |
| Awh Connected | $38 - $76 | N/A |
| Hygeia Corporation | $38 - $75 | N/A |
| Cigna | $38 - $75 | N/A |
| Springtide | $38 - $75 | N/A |
| Lw Miller | $38 - $75 | N/A |
| Tanner LLC | $38 - $75 | N/A |
| Deseret Mutual | $38 - $75 | N/A |
| Motivhealth | $38 - $75 | N/A |
| Juniper Systems | $38 - $75 | N/A |
| Global Excel | $38 - $75 | N/A |
| Byu Athletics | $38 - $75 | N/A |
| Health Utah | $38 - $75 | N/A |
| Medcare International | $38 - $75 | N/A |
| Franklin County | $38 - $75 | N/A |
| Emi Health | $38 - $75 | N/A |
| Ifit | $38 - $75 | N/A |
| Emi | $38 - $75 | N/A |
| Campbell Scientific | $38 - $75 | N/A |
| Prodegi Corp Benefit | $38 - $75 | N/A |
| Pehp | $38 - $75 | N/A |
| Managed Care Admin | $38 - $75 | N/A |
| Wise Network | $38 - $75 | N/A |
| Utah Tech | $38 - $75 | N/A |
| Uofu | $38 - $75 | N/A |