Western Peaks Specialty Hospital

All Charges

Charge

Type

Setting

Price

Isosource 1.5 8oz

Facility

$0.88

Hospital Revenue Code	270
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.44
Rate for Payer: SELF PAY	$0.44

IV DRESSING BIOPATCH

Facility

$24.78

Hospital Revenue Code	270
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$12.39
Rate for Payer: SELF PAY	$12.39

IV DRESSING BIOPATCH WP

Facility

$24.78

Hospital Revenue Code	270
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$12.39
Rate for Payer: SELF PAY	$12.39

IV EXTENSION SET

Facility

$5.04

Hospital Revenue Code	270
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$2.52
Rate for Payer: SELF PAY	$2.52

IV EXTENSION SET WP

Facility

$5.04

Hospital Revenue Code	270
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$2.52
Rate for Payer: SELF PAY	$2.52

IV VALVE CLAVE

Facility

$5.62

Hospital Revenue Code	270
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$2.81
Rate for Payer: SELF PAY	$2.81

IV VALVE CLAVE WP

Facility

$5.62

Hospital Revenue Code	270
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$2.81
Rate for Payer: SELF PAY	$2.81

JEVITY 1.2

Facility

$3.44

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

Jevity 1.2 1500ml

Facility

$5.20

Hospital Revenue Code	270
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$2.60
Rate for Payer: SELF PAY	$2.60

Jevity 1.2 8oz

Facility

$0.74

Hospital Revenue Code	270
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: SELF PAY	$0.37

JEVITY 1.2 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

JEVITY 1.5

Facility

$4.20

Hospital Revenue Code	270
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: SELF PAY	$2.10

Jevity 1.5 1500ml

Facility

$6.32

Hospital Revenue Code	270
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$3.16
Rate for Payer: SELF PAY	$3.16

Jevity 1.5 8oz

Facility

$0.80

Hospital Revenue Code	270
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.40
Rate for Payer: SELF PAY	$0.40

JEVITY 1.5 WP

Facility

$4.20

Hospital Revenue Code	270
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: SELF PAY	$2.10

Juven Therapeutic Powder

Facility

$5.16

Hospital Revenue Code	270
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$2.58
Rate for Payer: SELF PAY	$2.58

KATE FARMS 1.4

Facility

$5.64

Hospital Revenue Code	270
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$2.82
Rate for Payer: SELF PAY	$2.82

KATE FARMS 1.4 WP

Facility

$5.64

Hospital Revenue Code	270
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$2.82
Rate for Payer: SELF PAY	$2.82

KATE FARMS 1.5

Facility

$9.66

Hospital Revenue Code	270
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$4.83
Rate for Payer: SELF PAY	$4.83

KATE FARMS 1.5 BAG

Facility

$40.00

Hospital Revenue Code	270
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$20.00
Rate for Payer: SELF PAY	$20.00

KATE FARMS 1.5 BAG WP

Facility

$40.00

Hospital Revenue Code	270
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$20.00
Rate for Payer: SELF PAY	$20.00

KATE FARMS 1.5 WP

Facility

$9.66

Hospital Revenue Code	270
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$4.83
Rate for Payer: SELF PAY	$4.83

Kate Farms Glucose Support 1.2

Facility

$5.08

Hospital Revenue Code	270
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$2.54
Rate for Payer: SELF PAY	$2.54

Kate Farms Glucose Support WP

Facility

$5.08

Hospital Revenue Code	270
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$2.54
Rate for Payer: SELF PAY	$2.54

Kate Farms Pediatric Peptide 1

Facility

$8.50

Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.25
Rate for Payer: SELF PAY	$4.25

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All Charges