Western Peaks Specialty Hospital

All Charges

Charge

Type

Setting

Price

FACE MASK

Facility

$200.00

Hospital Revenue Code	270
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$100.00
Rate for Payer: SELF PAY	$100.00

FACE TENT MASK

Facility

$4.18

Hospital Revenue Code	270
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.09
Rate for Payer: SELF PAY	$2.09

FBS

Facility

$5.35

Service Code	CPT 82947
Hospital Revenue Code	300
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$2.67
Rate for Payer: SELF PAY	$2.67

FECAL MANAGEMENT SYSTEM KIT

Facility

$489.68

Hospital Revenue Code	270
Min. Negotiated Rate	$244.84
Max. Negotiated Rate	$244.84
Rate for Payer: SELF PAY	$244.84

FECAL MANAGEMENT SYSTEM KIT WP

Facility

$489.68

Hospital Revenue Code	270
Min. Negotiated Rate	$244.84
Max. Negotiated Rate	$244.84
Rate for Payer: SELF PAY	$244.84

FECAL OCCULT BLOOD

Facility

$8.99

Service Code	CPT 82274
Hospital Revenue Code	300
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: SELF PAY	$4.50

Feeding Pump

Facility

$5.06

Hospital Revenue Code	290
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: SELF PAY	$2.53

Feeding Pump Set

Facility

$10.60

Hospital Revenue Code	290
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$5.30
Rate for Payer: SELF PAY	$5.30

FE (IRON)

Facility

$3.16

Service Code	CPT 23540
Hospital Revenue Code	300
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$1.58
Rate for Payer: SELF PAY	$1.58

Female reproductive system reconstructive procedures

Facility

$112,000.00

Service Code	MSDRG 748
Min. Negotiated Rate	$62,443.10
Max. Negotiated Rate	$69,381.22
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$69,381.22
Rate for Payer: American Health Plans Medicare Advantage	$69,381.22
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$69,381.22
Rate for Payer: CIGNA Medicare Advantage	$69,381.22
Rate for Payer: HealthChoice Utah Medicare Advantage	$69,381.22
Rate for Payer: Humana Medicare Advantage	$69,381.22
Rate for Payer: Medicare	$69,381.22
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$69,381.22
Rate for Payer: MOLINA MEDICARE	$69,381.22
Rate for Payer: Pacific Source Medicare Advantage	$69,381.22
Rate for Payer: Select Health Medicare Advantage	$69,381.22
Rate for Payer: SELF PAY	$56,000.00
Rate for Payer: Tricare West Military	$62,443.10

FERRITIN

Facility

$28.00

Service Code	CPT 23540
Hospital Revenue Code	300
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$14.00
Rate for Payer: SELF PAY	$14.00

Fever and inflammatory conditions

Facility

$60,800.00

Service Code	MSDRG 864
Min. Negotiated Rate	$24,374.11
Max. Negotiated Rate	$27,082.35
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$27,082.35
Rate for Payer: American Health Plans Medicare Advantage	$27,082.35
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$27,082.35
Rate for Payer: CIGNA Medicare Advantage	$27,082.35
Rate for Payer: HealthChoice Utah Medicare Advantage	$27,082.35
Rate for Payer: Humana Medicare Advantage	$27,082.35
Rate for Payer: Medicare	$27,082.35
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$27,082.35
Rate for Payer: MOLINA MEDICARE	$27,082.35
Rate for Payer: Pacific Source Medicare Advantage	$27,082.35
Rate for Payer: Select Health Medicare Advantage	$27,082.35
Rate for Payer: SELF PAY	$30,400.00
Rate for Payer: Tricare West Military	$24,374.11

FIBRINOGEN

Facility

$34.00

Service Code	CPT 85384
Hospital Revenue Code	300
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: SELF PAY	$17.00

FILTER LINE TRAC H SET ADULT/P

Facility

$28.60

Hospital Revenue Code	270
Min. Negotiated Rate	$14.30
Max. Negotiated Rate	$14.30
Rate for Payer: SELF PAY	$14.30

FINGERNAIL CLIPPER

Facility

$0.56

Hospital Revenue Code	270
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.28
Rate for Payer: SELF PAY	$0.28

FINGERNAIL CLIPPER WP

Facility

$0.56

Hospital Revenue Code	270
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.28
Rate for Payer: SELF PAY	$0.28

FISHER PAYKEL CHAMBER

Facility

$26.88

Hospital Revenue Code	270
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$13.44
Rate for Payer: SELF PAY	$13.44

FIS/Paykel Humidifier Q

Facility

$100.52

Hospital Revenue Code	290
Min. Negotiated Rate	$50.26
Max. Negotiated Rate	$50.26
Rate for Payer: SELF PAY	$50.26

FLEXI-SEAL FMS COLLECTION BAG

Facility

$16.22

Hospital Revenue Code	270
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$8.11
Rate for Payer: SELF PAY	$8.11

FLEXI-SEAL FMS COLLECTION BAGS

Facility

$16.22

Hospital Revenue Code	270
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$8.11
Rate for Payer: SELF PAY	$8.11

FLEXI TUBE,6, 15MM TAPERED VAP

Facility

$20.80

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

Floor Bed

Facility

$52.00

Hospital Revenue Code	290
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$26.00
Rate for Payer: SELF PAY	$26.00

Fluid Elite II

Facility

$144.60

Hospital Revenue Code	290
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$72.30
Rate for Payer: SELF PAY	$72.30

FLUID TRIGLYCERIDE

Facility

$21.00

Service Code	CPT 84478
Hospital Revenue Code	300
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$10.50
Rate for Payer: SELF PAY	$10.50

FLUTTER VALVE IPEP

Facility

$99.90

Hospital Revenue Code	270
Min. Negotiated Rate	$49.95
Max. Negotiated Rate	$49.95
Rate for Payer: SELF PAY	$49.95

Know your out-of-pocket cost for care.

All Charges