Western Peaks Specialty Hospital

All Charges

Charge

Type

Setting

Price

CATH CONDOM LARGE OPTIMA

Facility

$2.88

Hospital Revenue Code	270
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: SELF PAY	$1.44

CATH CONDOM LARGE OPTIMA WP

Facility

$2.88

Hospital Revenue Code	270
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: SELF PAY	$1.44

CATH CONDOM MEDIUM OPTIMA

Facility

$2.88

Hospital Revenue Code	270
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: SELF PAY	$1.44

CATH CONDOM MEDIUM OPTIMA WP

Facility

$2.88

Hospital Revenue Code	270
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: SELF PAY	$1.44

CATH CONDOM SMALL OPTIMA

Facility

$2.74

Hospital Revenue Code	270
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$1.37
Rate for Payer: SELF PAY	$1.37

CATH CONDOM SMALL OPTIMA WP

Facility

$2.74

Hospital Revenue Code	270
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$1.37
Rate for Payer: SELF PAY	$1.37

CATHETER PLUG

Facility

$1.02

Hospital Revenue Code	270
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.51
Rate for Payer: SELF PAY	$0.51

CATH FOLEY 10FR COUDE

Facility

$1.64

Hospital Revenue Code	270
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: SELF PAY	$0.82

Cath Foley 14fr (100% Silicone

Facility

$7.56

Hospital Revenue Code	270
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$3.78
Rate for Payer: SELF PAY	$3.78

CATH FOLEY 16FR 30cc

Facility

$1.76

Hospital Revenue Code	270
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: SELF PAY	$0.88

CATH FOLEY 16FR COUDE TIP

Facility

$10.58

Hospital Revenue Code	270
Min. Negotiated Rate	$5.29
Max. Negotiated Rate	$5.29
Rate for Payer: SELF PAY	$5.29

CATH FOLEY 18FR 30cc

Facility

$20.80

Hospital Revenue Code	270
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$10.40
Rate for Payer: SELF PAY	$10.40

CATH FOLEY 20FR 30cc

Facility

$12.52

Hospital Revenue Code	270
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$6.26
Rate for Payer: SELF PAY	$6.26

CATH FOLEY 22FR 30cc

Facility

$5.14

Hospital Revenue Code	270
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$2.57
Rate for Payer: SELF PAY	$2.57

CATH FOLEY 22FR 30cc WP

Facility

$5.14

Hospital Revenue Code	270
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$2.57
Rate for Payer: SELF PAY	$2.57

CATH FOLEY 24FR 30cc

Facility

$5.14

Hospital Revenue Code	270
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$2.57
Rate for Payer: SELF PAY	$2.57

CATH FOLEY 24FR 30cc WP

Facility

$5.14

Hospital Revenue Code	270
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$2.57
Rate for Payer: SELF PAY	$2.57

CATH FOLEY 26FR 30cc

Facility

$3.86

Hospital Revenue Code	270
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: SELF PAY	$1.93

CATH FOLEY 26FR 30cc WP

Facility

$3.86

Hospital Revenue Code	270
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: SELF PAY	$1.93

CATH FOLEY 28FR 30cc

Facility

$2.20

Hospital Revenue Code	270
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.10
Rate for Payer: SELF PAY	$1.10

CATH FOLEY 30FR 30cc

Facility

$2.86

Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: SELF PAY	$1.43

CATH FOLEY 30FR 30cc WP

Facility

$2.86

Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: SELF PAY	$1.43

CATHGRIP MEDIUM

Facility

$22.70

Hospital Revenue Code	270
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: SELF PAY	$11.35

CATH KIT FEMALE

Facility

$8.18

Hospital Revenue Code	270
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$4.09
Rate for Payer: SELF PAY	$4.09

CATH LEG STRAP

Facility

$8.20

Hospital Revenue Code	270
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.10
Rate for Payer: SELF PAY	$4.10

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All Charges