Western Peaks Specialty Hospital

All Charges

Charge

Type

Setting

Price

02 CONNECTOR 1/4" STRAIGHT WP

Facility

$0.24

Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: SELF PAY	$0.12

0.9% SODIUM CHLORIDE 250ml IV

Facility

$5.66

Hospital Revenue Code	270
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: SELF PAY	$2.83

100 mm Disposable Red Guedel A

Facility

$0.60

Hospital Revenue Code	270
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: SELF PAY	$0.30

10FR STRAIGHT CATH

Facility

$1.30

Hospital Revenue Code	270
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.65
Rate for Payer: SELF PAY	$0.65

120 mm Disposable Purple Guede

Facility

$1.40

Hospital Revenue Code	270
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: SELF PAY	$0.70

12mL ENFIT SYRINGE

Facility

$0.80

Hospital Revenue Code	270
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.40
Rate for Payer: SELF PAY	$0.40

15mmOD x 22mmOD ADAPTER

Facility

$2.50

Hospital Revenue Code	270
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: SELF PAY	$1.25

15mmOD x 22mmOD ADAPTER WP

Facility

$2.50

Hospital Revenue Code	270
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: SELF PAY	$1.25

18 FR SILICONE SPT DUETTE CATH

Facility

$20.14

Hospital Revenue Code	270
Min. Negotiated Rate	$10.07
Max. Negotiated Rate	$10.07
Rate for Payer: SELF PAY	$10.07

1 Floor Mat

Facility

$133.00

Hospital Revenue Code	290
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$66.50
Rate for Payer: SELF PAY	$66.50

24HR ORAL CARE KIT WP

Facility

$68.90

Hospital Revenue Code	270
Min. Negotiated Rate	$34.45
Max. Negotiated Rate	$34.45
Rate for Payer: SELF PAY	$34.45

2.5 mm ET Tube

Facility

$9.22

Hospital Revenue Code	270
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$4.61
Rate for Payer: SELF PAY	$4.61

300 Wound surface air matt

Facility

$20.50

Hospital Revenue Code	290
Min. Negotiated Rate	$10.25
Max. Negotiated Rate	$10.25
Rate for Payer: SELF PAY	$10.25

3.0 mm ET Tube

Facility

$89.82

Hospital Revenue Code	270
Min. Negotiated Rate	$44.91
Max. Negotiated Rate	$44.91
Rate for Payer: SELF PAY	$44.91

3.0 NEO CUFFED FLEXTEND BIVONA

Facility

$475.40

Hospital Revenue Code	270
Min. Negotiated Rate	$237.70
Max. Negotiated Rate	$237.70
Rate for Payer: SELF PAY	$237.70

3.5 mm ET Tube

Facility

$9.22

Hospital Revenue Code	270
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$4.61
Rate for Payer: SELF PAY	$4.61

36" ALAL 3000 Mattress

Facility

$20.00

Hospital Revenue Code	290
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$10.00
Rate for Payer: SELF PAY	$10.00

3XL SLIPPER SOCK (ROYAL BLUE)

Facility

$3.60

Hospital Revenue Code	270
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: SELF PAY	$1.80

4.0 mm ET Tube

Facility

$8.98

Hospital Revenue Code	270
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$4.49
Rate for Payer: SELF PAY	$4.49

42" ALAL 3000 Bari Mattress

Facility

$24.00

Hospital Revenue Code	290
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: SELF PAY	$12.00

4.5 Bivona Pediatric flextend

Facility

$217.04

Hospital Revenue Code	270
Min. Negotiated Rate	$108.52
Max. Negotiated Rate	$108.52
Rate for Payer: SELF PAY	$108.52

4.5 mm ET Tube

Facility

$8.98

Hospital Revenue Code	270
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$4.49
Rate for Payer: SELF PAY	$4.49

48" ALAL Mattress

Facility

$28.00

Hospital Revenue Code	290
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$14.00
Rate for Payer: SELF PAY	$14.00

5.0 PDL PEDIATRIC TRACH

Facility

$215.58

Hospital Revenue Code	270
Min. Negotiated Rate	$107.79
Max. Negotiated Rate	$107.79
Rate for Payer: SELF PAY	$107.79

5 in 1 connector

Facility

$0.82

Hospital Revenue Code	270
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: SELF PAY	$0.41

Know your out-of-pocket cost for care.

All Charges