Western Peaks Specialty Hospital

All Charges

Charge

Type

Setting

Price

Endotracheal Tube Oral/Nasal

Facility

$9.46

Hospital Revenue Code	270
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$4.73
Rate for Payer: SELF PAY	$4.73

Endovascular cardiac valve replacement and supplement procedures with MCC

Facility

$86,400.00

Service Code	MSDRG 266
Min. Negotiated Rate	$41,788.22
Max. Negotiated Rate	$46,431.36
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$46,431.36
Rate for Payer: American Health Plans Medicare Advantage	$46,431.36
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$46,431.36
Rate for Payer: CIGNA Medicare Advantage	$46,431.36
Rate for Payer: HealthChoice Utah Medicare Advantage	$46,431.36
Rate for Payer: Humana Medicare Advantage	$46,431.36
Rate for Payer: Medicare	$46,431.36
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$46,431.36
Rate for Payer: MOLINA MEDICARE	$46,431.36
Rate for Payer: Pacific Source Medicare Advantage	$46,431.36
Rate for Payer: Select Health Medicare Advantage	$46,431.36
Rate for Payer: SELF PAY	$43,200.00
Rate for Payer: Tricare West Military	$41,788.22

Endovascular cardiac valve replacement and supplement procedures without MCC

Facility

$86,400.00

Service Code	MSDRG 267
Min. Negotiated Rate	$41,788.22
Max. Negotiated Rate	$46,431.36
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$46,431.36
Rate for Payer: American Health Plans Medicare Advantage	$46,431.36
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$46,431.36
Rate for Payer: CIGNA Medicare Advantage	$46,431.36
Rate for Payer: HealthChoice Utah Medicare Advantage	$46,431.36
Rate for Payer: Humana Medicare Advantage	$46,431.36
Rate for Payer: Medicare	$46,431.36
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$46,431.36
Rate for Payer: MOLINA MEDICARE	$46,431.36
Rate for Payer: Pacific Source Medicare Advantage	$46,431.36
Rate for Payer: Select Health Medicare Advantage	$46,431.36
Rate for Payer: SELF PAY	$43,200.00
Rate for Payer: Tricare West Military	$41,788.22

ENEMA MINERAL OIL

Facility

$3.18

Hospital Revenue Code	270
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$1.59
Rate for Payer: SELF PAY	$1.59

ENEMA MINERAL OIL WP

Facility

$3.18

Hospital Revenue Code	270
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$1.59
Rate for Payer: SELF PAY	$1.59

ENEMA PHOSPHATE

Facility

$2.30

Hospital Revenue Code	270
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.15
Rate for Payer: SELF PAY	$1.15

ENEMA PHOSPHATE WP

Facility

$2.30

Hospital Revenue Code	270
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.15
Rate for Payer: SELF PAY	$1.15

ENEMA SET BAG 1500CC

Facility

$1.78

Hospital Revenue Code	270
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: SELF PAY	$0.89

ENFIT FARRELL

Facility

$17.36

Hospital Revenue Code	270
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$8.68
Rate for Payer: SELF PAY	$8.68

ENFIT FARRELL WP

Facility

$17.36

Hospital Revenue Code	270
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$8.68
Rate for Payer: SELF PAY	$8.68

ENFIT FEEDING SYRINGE

Facility

$0.62

Hospital Revenue Code	270
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: SELF PAY	$0.31

ENFIT FEEDING SYRINGE WP

Facility

$0.62

Hospital Revenue Code	270
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: SELF PAY	$0.31

ENFIT GASTRO TUBE 14FR

Facility

$57.46

Hospital Revenue Code	270
Min. Negotiated Rate	$28.73
Max. Negotiated Rate	$28.73
Rate for Payer: SELF PAY	$28.73

ENFIT GASTRO TUBE 14FR WP

Facility

$57.46

Hospital Revenue Code	270
Min. Negotiated Rate	$28.73
Max. Negotiated Rate	$28.73
Rate for Payer: SELF PAY	$28.73

ENFIT GASTRO TUBE 16FR

Facility

$41.30

Hospital Revenue Code	270
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$20.65
Rate for Payer: SELF PAY	$20.65

ENFIT GASTRO TUBE 16FR WP

Facility

$41.30

Hospital Revenue Code	270
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$20.65
Rate for Payer: SELF PAY	$20.65

ENFIT GASTRO TUBE 18FR

Facility

$41.30

Hospital Revenue Code	270
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$20.65
Rate for Payer: SELF PAY	$20.65

ENFIT GASTRO TUBE 18FR WP

Facility

$41.30

Hospital Revenue Code	270
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$20.65
Rate for Payer: SELF PAY	$20.65

ENFIT GASTRO TUBE 20FR

Facility

$40.48

Hospital Revenue Code	270
Min. Negotiated Rate	$20.24
Max. Negotiated Rate	$20.24
Rate for Payer: SELF PAY	$20.24

ENFIT GASTRO TUBE 20FR WP

Facility

$40.48

Hospital Revenue Code	270
Min. Negotiated Rate	$20.24
Max. Negotiated Rate	$20.24
Rate for Payer: SELF PAY	$20.24

ENFIT GASTRO TUBE 22FR

Facility

$41.30

Hospital Revenue Code	270
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$20.65
Rate for Payer: SELF PAY	$20.65

ENFIT GASTRO TUBE 22FR WP

Facility

$41.30

Hospital Revenue Code	270
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$20.65
Rate for Payer: SELF PAY	$20.65

ENFIT GASTRO TUBE 24FR

Facility

$57.46

Hospital Revenue Code	270
Min. Negotiated Rate	$28.73
Max. Negotiated Rate	$28.73
Rate for Payer: SELF PAY	$28.73

ENFIT GASTRO TUBE 24FR WP

Facility

$57.46

Hospital Revenue Code	270
Min. Negotiated Rate	$28.73
Max. Negotiated Rate	$28.73
Rate for Payer: SELF PAY	$28.73

ENFIT MIC-KEY EXTENSION SET

Facility

$24.06

Hospital Revenue Code	270
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$12.03
Rate for Payer: SELF PAY	$12.03

Know your out-of-pocket cost for care.

All Charges