Western Peaks Specialty Hospital

All Charges

Charge

Type

Setting

Price

BIVONA CUFFLESS ADULT TRACH 5.

Facility

$180.14

Hospital Revenue Code	270
Min. Negotiated Rate	$90.07
Max. Negotiated Rate	$90.07
Rate for Payer: SELF PAY	$90.07

BIVONA CUSTOM TRACH 3.0 NSF997

Facility

$740.00

Hospital Revenue Code	270
Min. Negotiated Rate	$370.00
Max. Negotiated Rate	$370.00
Rate for Payer: SELF PAY	$370.00

BIVONA CUSTOM TRACH 3.5 NSE871

Facility

$740.00

Hospital Revenue Code	270
Min. Negotiated Rate	$370.00
Max. Negotiated Rate	$370.00
Rate for Payer: SELF PAY	$370.00

BIVONA CUSTOM TRACH 4.0 NSF969

Facility

$740.00

Hospital Revenue Code	270
Min. Negotiated Rate	$370.00
Max. Negotiated Rate	$370.00
Rate for Payer: SELF PAY	$370.00

BIVONA CUSTOM TRACH 4.5 NSF098

Facility

$740.00

Hospital Revenue Code	270
Min. Negotiated Rate	$370.00
Max. Negotiated Rate	$370.00
Rate for Payer: SELF PAY	$370.00

Bivona Custom Trach FP20LN40NS

Facility

$650.00

Hospital Revenue Code	270
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$325.00
Rate for Payer: SELF PAY	$325.00

BIVONA CUSTOM TRACH NSE121N

Facility

$740.00

Hospital Revenue Code	270
Min. Negotiated Rate	$370.00
Max. Negotiated Rate	$370.00
Rate for Payer: SELF PAY	$370.00

BIVONA TRACH CUFFED 6.0 ADULT

Facility

$287.02

Hospital Revenue Code	270
Min. Negotiated Rate	$143.51
Max. Negotiated Rate	$143.51
Rate for Payer: SELF PAY	$143.51

BIVONA TRACH FLEX 5.5 PED

Facility

$219.84

Hospital Revenue Code	270
Min. Negotiated Rate	$109.92
Max. Negotiated Rate	$109.92
Rate for Payer: SELF PAY	$109.92

BIVONA UNCUFFED 3.0 NEO

Facility

$161.30

Hospital Revenue Code	270
Min. Negotiated Rate	$80.65
Max. Negotiated Rate	$80.65
Rate for Payer: SELF PAY	$80.65

BIVONA UNCUFFED FLEX 4.0 PED

Facility

$217.04

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

BIVONA UNCUFFED FLEXTEND TRACH

Facility

$217.04

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

BIVONA UNCUFFED FLEX TRACH 3.5

Facility

$217.04

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

BIVONA UNCUFFED TRACH 3.0 PED

Facility

$160.02

Hospital Revenue Code	270
Min. Negotiated Rate	$80.01
Max. Negotiated Rate	$80.01
Rate for Payer: SELF PAY	$80.01

BIVONA UNCUFFED TRACH 4.0 PED

Facility

$406.38

Hospital Revenue Code	270
Min. Negotiated Rate	$203.19
Max. Negotiated Rate	$203.19
Rate for Payer: SELF PAY	$203.19
Rate for Payer: SELF PAY	$80.01

BIVONA UNCUFFED TRACH 4.5 PED

Facility

$160.02

Hospital Revenue Code	270
Min. Negotiated Rate	$80.01
Max. Negotiated Rate	$80.01
Rate for Payer: SELF PAY	$80.01
Rate for Payer: SELF PAY	$203.19

BLOOD CULTURE

Facility

$11.90

Service Code	CPT 87040
Hospital Revenue Code	300
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$5.95
Rate for Payer: SELF PAY	$5.95

BLOOD GLUCOSE METER

Facility

$0.04

Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: SELF PAY	$0.02

BLUE HEATED WIRE FISHER PAYKEL

Facility

$250.00

Hospital Revenue Code	270
Min. Negotiated Rate	$125.00
Max. Negotiated Rate	$125.00
Rate for Payer: SELF PAY	$125.00

BLUE URINAL HOLDER

Facility

$8.68

Hospital Revenue Code	270
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$4.34
Rate for Payer: SELF PAY	$4.34

BLUE URINAL HOLDER WP

Facility

$8.68

Hospital Revenue Code	270
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$4.34
Rate for Payer: SELF PAY	$4.34

BLUE WASHCLOTHES

Facility

$15.12

Hospital Revenue Code	270
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$7.56
Rate for Payer: SELF PAY	$7.56

BLUE WASHCLOTHES WP

Facility

$15.12

Hospital Revenue Code	270
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$7.56
Rate for Payer: SELF PAY	$7.56

BMP

Facility

$9.70

Service Code	CPT 80048
Hospital Revenue Code	300
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$4.85
Rate for Payer: SELF PAY	$4.85

BNP

Facility

$15.00

Service Code	CPT 83880
Hospital Revenue Code	300
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: SELF PAY	$7.50

Know your out-of-pocket cost for care.

All Charges