Shoppable Services at Heber Valley Hospital

General Disclosure

The list 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
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE 1-800 Contacts 1-800 Contacts $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Wise Wise Network $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE WCF Insurance WCF Insurance $165.89 $159.26 $199.07 $165.89 $165.89 $159.26 $199.07 $165.89 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Utah Cancer Control Program (UCCP) Utah Cancer Control Program (UCCP) $165.89 $159.26 $199.07 $0.00 $165.89 $159.26 $199.07 $0.00 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE University of Utah University of Utah Healthy Preferred $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE University of Utah University of Utah Healthy Preferred - Marketplace $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE University of Utah University of Utah Healthy Premier $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE University of Utah University of Utah Healthy Premier - Marketplace $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE United States Ski & Snowboard Association United States Ski & Snowboard Association $165.89 $159.26 $199.07 $199.07 $165.89 $159.26 $199.07 $199.07 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE United Healthcare United Healthcare Options PPO $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE United Healthcare United Healthcare Choice Plus Network $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Union Pacific Railroad Employes Health Union Pacific Railroad Employes Health $165.89 $159.26 $199.07 $199.07 $165.89 $159.26 $199.07 $199.07 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Tanner LLC Tanner LLC $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE SpringTide SpringTide $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Sinclair Services Company Sinclair Services Company $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE SelectHealth SelectHealth Value Network Individual Plan (ACA) $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE SelectHealth SelectHealth Care Network $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE SelectHealth SelectHealth Community Care-Medicaid $165.89 $159.26 $199.07 $196.86 $165.89 $159.26 $199.07 $0.00 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE SelectHealth SelectHealth Med Network $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE SelectHealth SelectHealth Med Network CHIP $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE SelectHealth SelectHealth Med Network Federal Employee (FEHBP) $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE SelectHealth SelectHealth Value Network $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE SelectHealth SelectHealth Share Network $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE SelectHealth SelectHealth Med Network Individual Plan (ACA) $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Regence BlueCross BlueShield of Utah Regence Focal Point $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Regence BlueCross BlueShield of Utah Regence Individual and Family Network $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Regence BlueCross BlueShield of Utah Regence BCBS Federal (FEHBP) $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Regence BlueCross BlueShield of Utah Regence Bridgespan RealValue $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Regence BlueCross BlueShield of Utah Regence BCBS Traditional Plan $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Regence BlueCross BlueShield of Utah Regence BCBS ValueCare $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Regence BlueCross BlueShield of Utah Regence BCBS Preferred BlueOption (PBO) $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Provider Networks of America Provider Networks of America (PNOA) $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Prodegi Corporate Benefit Services, LLC Prodegi Corporate Benefit Services, LLC $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Petersen, Inc. Petersen, Inc. $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE PEHP PEHP Advantage Care - Non State $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE PEHP PEHP Summit Care $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE PEHP PEHP Summit Exclusive $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE PEHP PEHP Preferred Care $165.89 $159.26 $199.07 $199.07 $165.89 $159.26 $199.07 $199.07 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE PEHP PEHP Capital Care $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE PEHP PEHP Advantage Care State Employees and Advantage Care Exclusive $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE MotivHealth MotivHealth $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Molina Healthcare of Utah Molina Healthcare Medicaid HMO $165.89 $159.26 $199.07 $196.86 $165.89 $159.26 $199.07 $0.00 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Molina Healthcare of Utah Molina CHIP $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Molina Healthcare of Utah Molina Marketplace $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE MedCare International, Inc. MedCare International, Inc. $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Managed Care Administrators, Inc. Managed Care Administrators, Inc. $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE LW Miller LW Miller $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Juniper Systems Juniper Systems $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Inovar Inovar $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Injury Care of Nevada Injury Care of Nevada $165.89 $159.26 $199.07 $165.89 $165.89 $159.26 $199.07 $165.89 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Icon Health Fitness Icon Health Fitness $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Hygeia Corporation Hygeia Corporation $165.89 $159.26 $199.07 $199.07 $165.89 $159.26 $199.07 $199.07 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Humana Humana ChoiceCare $165.89 $159.26 $199.07 $199.07 $165.89 $159.26 $199.07 $199.07 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Healthy U Healthy U-Medicaid $165.89 $159.26 $199.07 $196.86 $165.89 $159.26 $199.07 $0.00 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE HealthSCOPE Benefits, Inc. HealthSCOPE Benefits, Inc. $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Health Utah Health Utah $165.89 $159.26 $199.07 $199.07 $165.89 $159.26 $199.07 $199.07 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Health Plan of Nevada Medicaid Health Plan of Nevada Medicaid (HPN) $165.89 $159.26 $199.07 $196.86 $165.89 $159.26 $199.07 $0.00 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Health Choice Utah Health Choice Utah-Medicaid $165.89 $159.26 $199.07 $196.86 $165.89 $159.26 $199.07 $0.00 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Global Excel Global Excel $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Franklin County Medical Center Franklin County Medical Center $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Franklin County Franklin County $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE EMI Health EMI Health Choice $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE EMI Health EMI Health $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE EMI Health EMI Health Network Care $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Dixie State University Dixie State University $165.89 $159.26 $199.07 $159.26 $165.89 $159.26 $199.07 $159.26 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Deseret Mutual DMBA Deseret Select $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Deseret Mutual DMBA Deseret Premier $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Deseret Mutual DMBA Deseret Value $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Corporation of the President Corporation of the President $165.89 $159.26 $199.07 $165.89 $165.89 $159.26 $199.07 $165.89 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE CorVel Corporation CorVel Corporation $165.89 $159.26 $199.07 $165.89 $165.89 $159.26 $199.07 $165.89 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Cigna Healthcare CIGNA Utah Connect $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Cigna Healthcare CIGNA PPO and EPO $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Cigna Healthcare CIGNA Managed Care (HMO or Open Access Plus aka OAP) $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Campbell Scientific Campbell Scientific $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Big-D Construction Big-D Construction $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE BYU Risk Management BYU Risk Management $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE BYU Athletic Department BYU Athletic Department $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE BCBS OOS -TRAD BCBS Association-Blue Card Traditional Plan $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE BCBS OOS - PPO BCBS Association-Blue Card PPO Plan $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Altius Altius (Coventry) Limited Facility $165.89 $159.26 $199.07 $188.01 $165.89 $159.26 $199.07 $188.01 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Aetna Aetna Utah Connected Network $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $194.65 $221.19
1100000056 4624449 10120 EDPHY-INCISION & REMOVAL FOREIGN BODY SIMPLE Aetna Aetna Standard Network AKA Aetna Health Plan Network for Utah $165.89 $159.26 $199.07 $192.44 $165.89 $159.26 $199.07 $192.44 $221.19
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST 1-800 Contacts 1-800 Contacts $169.52 $162.74 $203.43 $196.65 $169.52 $162.74 $203.43 $196.65 $226.03
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST Deseret Mutual DMBA Deseret Select $169.52 $162.74 $203.43 $196.65 $169.52 $162.74 $203.43 $196.65 $226.03
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST Deseret Mutual DMBA Deseret Value $169.52 $162.74 $203.43 $196.65 $169.52 $162.74 $203.43 $196.65 $226.03
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST Deseret Mutual DMBA Deseret Premier $169.52 $162.74 $203.43 $196.65 $169.52 $162.74 $203.43 $196.65 $226.03
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST Corporation of the President Corporation of the President $169.52 $162.74 $203.43 $169.52 $169.52 $162.74 $203.43 $169.52 $226.03
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST CorVel Corporation CorVel Corporation $169.52 $162.74 $203.43 $169.52 $169.52 $162.74 $203.43 $169.52 $226.03
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST Cigna Healthcare CIGNA PPO and EPO $169.52 $162.74 $203.43 $192.13 $169.52 $162.74 $203.43 $192.13 $226.03
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST Cigna Healthcare CIGNA Managed Care (HMO or Open Access Plus aka OAP) $169.52 $162.74 $203.43 $192.13 $169.52 $162.74 $203.43 $192.13 $226.03
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST Cigna Healthcare CIGNA Utah Connect $169.52 $162.74 $203.43 $192.13 $169.52 $162.74 $203.43 $192.13 $226.03
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST Campbell Scientific Campbell Scientific $169.52 $162.74 $203.43 $196.65 $169.52 $162.74 $203.43 $196.65 $226.03
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST Big-D Construction Big-D Construction $169.52 $162.74 $203.43 $196.65 $169.52 $162.74 $203.43 $196.65 $226.03
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST BYU Risk Management BYU Risk Management $169.52 $162.74 $203.43 $192.13 $169.52 $162.74 $203.43 $192.13 $226.03
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST BYU Athletic Department BYU Athletic Department $169.52 $162.74 $203.43 $192.13 $169.52 $162.74 $203.43 $192.13 $226.03
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST BCBS OOS -TRAD BCBS Association-Blue Card Traditional Plan $169.52 $162.74 $203.43 $192.13 $169.52 $162.74 $203.43 $192.13 $226.03
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST BCBS OOS - PPO BCBS Association-Blue Card PPO Plan $169.52 $162.74 $203.43 $192.13 $169.52 $162.74 $203.43 $192.13 $226.03
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST Altius Altius (Coventry) Limited Facility $169.52 $162.74 $203.43 $192.13 $169.52 $162.74 $203.43 $192.13 $226.03
1100000077 4624451 10160 PHY-PUNCTURE ABSCESS HEMATOMA OR CYST Aetna Aetna Standard Network AKA Aetna Health Plan Network for Utah $169.52 $162.74 $203.43 $196.65 $169.52 $162.74 $203.43 $196.65 $226.03