Western Peaks Specialty Hospital

All Charges

Charge

Type

Setting

Price

CATH LEG STRAP WP

Facility

$8.20

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

CATH PROCEDURE TRAY W/O CATH 3

Facility

$4.92

Hospital Revenue Code	270
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.46
Rate for Payer: SELF PAY	$2.46

CATH SELF 12FR STRAIGHT TIP

Facility

$1.34

Hospital Revenue Code	270
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: SELF PAY	$0.67

CATH SELF 14FR TRAY

Facility

$3.44

Hospital Revenue Code	270
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$1.72
Rate for Payer: SELF PAY	$1.72

CATH SELF 14FR TRAY WP

Facility

$3.44

Hospital Revenue Code	270
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$1.72
Rate for Payer: SELF PAY	$1.72

CATH SELF 8FR PEDIATRIC

Facility

$1.28

Hospital Revenue Code	270
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.64
Rate for Payer: SELF PAY	$0.64

CATH SELF TIEMAN COUDE 14FR

Facility

$3.76

Hospital Revenue Code	270
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: SELF PAY	$1.88

CATH SELF TIEMAN COUDE 16FR

Facility

$3.76

Hospital Revenue Code	270
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: SELF PAY	$1.88

CATH TRAY 14FR

Facility

$38.78

Hospital Revenue Code	270
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$19.39
Rate for Payer: SELF PAY	$19.39

CATH TRAY 14FR WP

Facility

$38.78

Hospital Revenue Code	270
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$19.39
Rate for Payer: SELF PAY	$19.39

CATH TRAY 16FR

Facility

$38.78

Hospital Revenue Code	270
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$19.39
Rate for Payer: SELF PAY	$19.39

CATH TRAY 16FR WP

Facility

$38.78

Hospital Revenue Code	270
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$19.39
Rate for Payer: SELF PAY	$19.39

CATH TRAY 18FR

Facility

$38.78

Hospital Revenue Code	270
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$19.39
Rate for Payer: SELF PAY	$19.39

CATH TRAY 18FR WP

Facility

$38.78

Hospital Revenue Code	270
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$19.39
Rate for Payer: SELF PAY	$19.39

CBC

Facility

$6.50

Service Code	CPT 85027
Hospital Revenue Code	300
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$3.25
Rate for Payer: SELF PAY	$3.25

CBC with DIFF

Facility

$6.10

Service Code	CPT 85025
Hospital Revenue Code	300
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$3.05
Rate for Payer: SELF PAY	$3.05

CBC W/ PLATELETS

Facility

$6.55

Service Code	CPT 85049
Hospital Revenue Code	300
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$3.27
Rate for Payer: SELF PAY	$3.27

C-DIFF

Facility

$31.80

Service Code	CPT 87493
Hospital Revenue Code	300
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: SELF PAY	$15.90

C-DIFF 027

Facility

$63.60

Service Code	CPT 87493
Hospital Revenue Code	300
Min. Negotiated Rate	$31.80
Max. Negotiated Rate	$31.80
Rate for Payer: SELF PAY	$31.80

C-DIFF B GENE BY PCR

Facility

$31.80

Service Code	CPT 87493
Hospital Revenue Code	300
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: SELF PAY	$15.90

C DIFFICILE TOXIN

Facility

$69.00

Service Code	CPT 87081
Hospital Revenue Code	300
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$34.50
Rate for Payer: SELF PAY	$34.50

Cellulitis with MCC

Facility

$64,000.00

Service Code	MSDRG 602
Min. Negotiated Rate	$27,474.16
Max. Negotiated Rate	$30,526.84
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$30,526.84
Rate for Payer: American Health Plans Medicare Advantage	$30,526.84
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$30,526.84
Rate for Payer: CIGNA Medicare Advantage	$30,526.84
Rate for Payer: HealthChoice Utah Medicare Advantage	$30,526.84
Rate for Payer: Humana Medicare Advantage	$30,526.84
Rate for Payer: Medicare	$30,526.84
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$30,526.84
Rate for Payer: MOLINA MEDICARE	$30,526.84
Rate for Payer: Pacific Source Medicare Advantage	$30,526.84
Rate for Payer: Select Health Medicare Advantage	$30,526.84
Rate for Payer: SELF PAY	$32,000.00
Rate for Payer: Tricare West Military	$27,474.16

Cellulitis without MCC

Facility

$57,600.00

Service Code	MSDRG 603
Min. Negotiated Rate	$21,483.16
Max. Negotiated Rate	$23,870.18
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$23,870.18
Rate for Payer: American Health Plans Medicare Advantage	$23,870.18
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$23,870.18
Rate for Payer: CIGNA Medicare Advantage	$23,870.18
Rate for Payer: HealthChoice Utah Medicare Advantage	$23,870.18
Rate for Payer: Humana Medicare Advantage	$23,870.18
Rate for Payer: Medicare	$23,870.18
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$23,870.18
Rate for Payer: MOLINA MEDICARE	$23,870.18
Rate for Payer: Pacific Source Medicare Advantage	$23,870.18
Rate for Payer: Select Health Medicare Advantage	$23,870.18
Rate for Payer: SELF PAY	$28,800.00
Rate for Payer: Tricare West Military	$21,483.16

Cervical Collar

Facility

$94.18

Hospital Revenue Code	270
Min. Negotiated Rate	$47.09
Max. Negotiated Rate	$47.09
Rate for Payer: SELF PAY	$47.09

CERVICAL COLLAR

Facility

$170.82

Hospital Revenue Code	270
Min. Negotiated Rate	$85.41
Max. Negotiated Rate	$85.41
Rate for Payer: SELF PAY	$85.41

Know your out-of-pocket cost for care.

All Charges