CMS Price Transparency Data

Hepatitis B vaccine

Facility: Holy Cross Hospital - Salt Lake

Billing Code: 90744 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90744
Insurance Median: $112
Cash Discount Price: $66
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Hepatitis B vaccine at Holy Cross Hospital - Salt Lake is $112. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $66. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1050 East South Temple, Salt Lake City, UT.

Cash / Self-Pay

$66

Average discount available for prompt cash payment at this facility.

Insurance Median

$112

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

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

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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
Blue Cross Blue Shield	$25 - $238	N/A
Uuhp	$26 - $33	N/A
Denver Health	$33	N/A
Humana	$33	N/A
Medicaid / KanCare	$33	N/A
Rocky Mountain Health Plan	$33	N/A
Medicare (plans)	$33	N/A
Health Choice	$33	N/A
Employer Direct Healthcare	$41	N/A
Motivhealth	$43	N/A
Centura Employee Plan	$55 - $139	N/A
Cigna	$57 - $317	N/A
Molina	$68 - $170	N/A
Pehp	$68 - $396	N/A
Aetna	$70 - $335	N/A
UnitedHealthcare	$73 - $182	N/A
Wise	$82 - $210	N/A
Multiplan	$93 - $361	N/A
Deseret Mutual Benefit Administrators	$97 - $243	N/A
Select Health	$105 - $262	N/A
Emi Health	$158 - $396	N/A

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $66.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: 90744.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Holy Cross Hospital - Salt Lake is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code 90744.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.