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
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Petersen, Inc. Petersen, Inc. $143.25 $54.00 $184.50 $166.17 $143.25 $54.00 $184.50 $166.17 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man United States Ski & Snowboard Association United States Ski & Snowboard Association $153.75 $54.00 $184.50 $174.25 $153.75 $54.00 $184.50 $174.25 $205.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS United States Ski & Snowboard Association United States Ski & Snowboard Association $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS United States Ski & Snowboard Association United States Ski & Snowboard Association $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS United Healthcare United Healthcare Choice Plus Network $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man United Healthcare United Healthcare Choice Plus Network $143.25 $54.00 $184.50 $162.35 $143.25 $54.00 $184.50 $162.35 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man United Healthcare United Healthcare Options PPO $153.75 $54.00 $184.50 $174.25 $153.75 $54.00 $184.50 $174.25 $205.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man United Healthcare United Healthcare Options PPO $143.25 $54.00 $184.50 $162.35 $143.25 $54.00 $184.50 $162.35 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man United Healthcare United Healthcare Choice Plus Network $153.75 $54.00 $184.50 $174.25 $153.75 $54.00 $184.50 $174.25 $205.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS United Healthcare United Healthcare Options PPO $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS United Healthcare United Healthcare Options PPO $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS United Healthcare United Healthcare Choice Plus Network $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Union Pacific Railroad Employes Health Union Pacific Railroad Employes Health $56.25 $54.00 $184.50 $67.50 $56.25 $54.00 $184.50 $67.50 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Union Pacific Railroad Employes Health Union Pacific Railroad Employes Health $56.25 $54.00 $184.50 $67.50 $56.25 $54.00 $184.50 $67.50 $75.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Union Pacific Railroad Employes Health Union Pacific Railroad Employes Health $153.75 $54.00 $184.50 $184.50 $153.75 $54.00 $184.50 $184.50 $205.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Union Pacific Railroad Employes Health Union Pacific Railroad Employes Health $143.25 $54.00 $184.50 $171.90 $143.25 $54.00 $184.50 $171.90 $191.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Tanner LLC Tanner LLC $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Tanner LLC Tanner LLC $153.75 $54.00 $184.50 $178.35 $153.75 $54.00 $184.50 $178.35 $205.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Tanner LLC Tanner LLC $143.25 $54.00 $184.50 $166.17 $143.25 $54.00 $184.50 $166.17 $191.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Tanner LLC Tanner LLC $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SpringTide SpringTide $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SpringTide SpringTide $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SpringTide SpringTide $153.75 $54.00 $184.50 $174.25 $153.75 $54.00 $184.50 $174.25 $205.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SpringTide SpringTide $143.25 $54.00 $184.50 $162.35 $143.25 $54.00 $184.50 $162.35 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Sinclair Services Company Sinclair Services Company $153.75 $54.00 $184.50 $178.35 $153.75 $54.00 $184.50 $178.35 $205.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Sinclair Services Company Sinclair Services Company $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Sinclair Services Company Sinclair Services Company $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Sinclair Services Company Sinclair Services Company $143.25 $54.00 $184.50 $166.17 $143.25 $54.00 $184.50 $166.17 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Med Network Individual Plan (ACA) $153.75 $54.00 $184.50 $178.35 $153.75 $54.00 $184.50 $178.35 $205.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Value Network $143.25 $54.00 $184.50 $166.17 $143.25 $54.00 $184.50 $166.17 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Value Network $153.75 $54.00 $184.50 $178.35 $153.75 $54.00 $184.50 $178.35 $205.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Med Network CHIP $143.25 $54.00 $184.50 $166.17 $143.25 $54.00 $184.50 $166.17 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Med Network $143.25 $54.00 $184.50 $166.17 $143.25 $54.00 $184.50 $166.17 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Share Network $153.75 $54.00 $184.50 $178.35 $153.75 $54.00 $184.50 $178.35 $205.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Share Network $143.25 $54.00 $184.50 $166.17 $143.25 $54.00 $184.50 $166.17 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Med Network Federal Employee (FEHBP) $153.75 $54.00 $184.50 $178.35 $153.75 $54.00 $184.50 $178.35 $205.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Med Network Federal Employee (FEHBP) $143.25 $54.00 $184.50 $166.17 $143.25 $54.00 $184.50 $166.17 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Care Network $143.25 $54.00 $184.50 $166.17 $143.25 $54.00 $184.50 $166.17 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Care Network $153.75 $54.00 $184.50 $178.35 $153.75 $54.00 $184.50 $178.35 $205.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Community Care-Medicaid $153.75 $54.00 $184.50 $182.45 $153.75 $54.00 $184.50 $0.00 $205.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Community Care-Medicaid $56.25 $54.00 $184.50 $66.75 $56.25 $54.00 $184.50 $0.00 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Community Care-Medicaid $56.25 $54.00 $184.50 $66.75 $56.25 $54.00 $184.50 $0.00 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Med Network $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Med Network $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Med Network CHIP $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Community Care-Medicaid $143.25 $54.00 $184.50 $169.99 $143.25 $54.00 $184.50 $0.00 $191.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Share Network $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Share Network $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Value Network Individual Plan (ACA) $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Value Network Individual Plan (ACA) $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Med Network Individual Plan (ACA) $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Med Network Individual Plan (ACA) $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Value Network $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Value Network $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Med Network CHIP $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Med Network Federal Employee (FEHBP) $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Med Network Federal Employee (FEHBP) $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Care Network $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Med Network CHIP $153.75 $54.00 $184.50 $178.35 $153.75 $54.00 $184.50 $178.35 $205.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Value Network Individual Plan (ACA) $153.75 $54.00 $184.50 $178.35 $153.75 $54.00 $184.50 $178.35 $205.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Value Network Individual Plan (ACA) $143.25 $54.00 $184.50 $166.17 $143.25 $54.00 $184.50 $166.17 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Med Network Individual Plan (ACA) $143.25 $54.00 $184.50 $166.17 $143.25 $54.00 $184.50 $166.17 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man SelectHealth SelectHealth Med Network $153.75 $54.00 $184.50 $178.35 $153.75 $54.00 $184.50 $178.35 $205.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS SelectHealth SelectHealth Care Network $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Regence BlueCross BlueShield of Utah Regence BCBS ValueCare $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Regence BlueCross BlueShield of Utah Regence Individual and Family Network $143.25 $54.00 $184.50 $162.35 $143.25 $54.00 $184.50 $162.35 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Regence BlueCross BlueShield of Utah Regence BCBS ValueCare $153.75 $54.00 $184.50 $174.25 $153.75 $54.00 $184.50 $174.25 $205.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Regence BlueCross BlueShield of Utah Regence BCBS ValueCare $143.25 $54.00 $184.50 $162.35 $143.25 $54.00 $184.50 $162.35 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Regence BlueCross BlueShield of Utah Regence Focal Point $143.25 $54.00 $184.50 $162.35 $143.25 $54.00 $184.50 $162.35 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Regence BlueCross BlueShield of Utah Regence Bridgespan RealValue $153.75 $54.00 $184.50 $174.25 $153.75 $54.00 $184.50 $174.25 $205.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Regence BlueCross BlueShield of Utah Regence Bridgespan RealValue $143.25 $54.00 $184.50 $162.35 $143.25 $54.00 $184.50 $162.35 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Regence BlueCross BlueShield of Utah Regence BCBS Preferred BlueOption (PBO) $143.25 $54.00 $184.50 $162.35 $143.25 $54.00 $184.50 $162.35 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Regence BlueCross BlueShield of Utah Regence BCBS Preferred BlueOption (PBO) $153.75 $54.00 $184.50 $174.25 $153.75 $54.00 $184.50 $174.25 $205.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Regence BlueCross BlueShield of Utah Regence BCBS Federal (FEHBP) $153.75 $54.00 $184.50 $174.25 $153.75 $54.00 $184.50 $174.25 $205.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Regence BlueCross BlueShield of Utah Regence BCBS Federal (FEHBP) $143.25 $54.00 $184.50 $162.35 $143.25 $54.00 $184.50 $162.35 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Regence BlueCross BlueShield of Utah Regence BCBS Traditional Plan $143.25 $54.00 $184.50 $162.35 $143.25 $54.00 $184.50 $162.35 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Regence BlueCross BlueShield of Utah Regence BCBS Traditional Plan $153.75 $54.00 $184.50 $174.25 $153.75 $54.00 $184.50 $174.25 $205.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Regence BlueCross BlueShield of Utah Regence Bridgespan RealValue $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Regence BlueCross BlueShield of Utah Regence BCBS Preferred BlueOption (PBO) $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Regence BlueCross BlueShield of Utah Regence Focal Point $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Regence BlueCross BlueShield of Utah Regence BCBS Preferred BlueOption (PBO) $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Regence BlueCross BlueShield of Utah Regence BCBS Federal (FEHBP) $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Regence BlueCross BlueShield of Utah Regence BCBS Federal (FEHBP) $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Regence BlueCross BlueShield of Utah Regence BCBS Traditional Plan $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Regence BlueCross BlueShield of Utah Regence Focal Point $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Regence BlueCross BlueShield of Utah Regence BCBS Traditional Plan $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Regence BlueCross BlueShield of Utah Regence Bridgespan RealValue $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Regence BlueCross BlueShield of Utah Regence Focal Point $153.75 $54.00 $184.50 $174.25 $153.75 $54.00 $184.50 $174.25 $205.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Regence BlueCross BlueShield of Utah Regence Individual and Family Network $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Regence BlueCross BlueShield of Utah Regence Individual and Family Network $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Regence BlueCross BlueShield of Utah Regence Individual and Family Network $153.75 $54.00 $184.50 $174.25 $153.75 $54.00 $184.50 $174.25 $205.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Regence BlueCross BlueShield of Utah Regence BCBS ValueCare $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Provider Networks of America Provider Networks of America (PNOA) $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Provider Networks of America Provider Networks of America (PNOA) $143.25 $54.00 $184.50 $162.35 $143.25 $54.00 $184.50 $162.35 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Provider Networks of America Provider Networks of America (PNOA) $153.75 $54.00 $184.50 $174.25 $153.75 $54.00 $184.50 $174.25 $205.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Provider Networks of America Provider Networks of America (PNOA) $56.25 $54.00 $184.50 $63.75 $56.25 $54.00 $184.50 $63.75 $75.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Prodegi Corporate Benefit Services, LLC Prodegi Corporate Benefit Services, LLC $143.25 $54.00 $184.50 $166.17 $143.25 $54.00 $184.50 $166.17 $191.00
99385 1025766 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS / Initial Comp Preventive Med 18 to 39 years New 99385 / Initial comprehensive preventive medicine evaluation and man Prodegi Corporate Benefit Services, LLC Prodegi Corporate Benefit Services, LLC $153.75 $54.00 $184.50 $178.35 $153.75 $54.00 $184.50 $178.35 $205.00
1999000490 1025766 99385 PHY-PREVENTIVE CARE NEW PT 18-39 YRS / PREVENTIVE CARE NEW PT 18-39 YRS Prodegi Corporate Benefit Services, LLC Prodegi Corporate Benefit Services, LLC $56.25 $54.00 $184.50 $65.25 $56.25 $54.00 $184.50 $65.25 $75.00