Western Peaks Specialty Hospital

All Charges

Charge

Type

Setting

Price

Ostomy Sensura Mio Click 50mm

Facility

$17.24

Hospital Revenue Code	270
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$8.62
Rate for Payer: SELF PAY	$8.62

Ostomy Sensura Mio Click 60mm

Facility

$17.24

Hospital Revenue Code	270
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$8.62
Rate for Payer: SELF PAY	$8.62

OSTOMY STOMAHESIVE POWDER

Facility

$12.00

Hospital Revenue Code	270
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: SELF PAY	$6.00

OSTOMY STOMAHESIVE POWDER WP

Facility

$12.00

Hospital Revenue Code	270
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: SELF PAY	$6.00

OT Eval

Facility

$135.00

Service Code	CPT 97003
Hospital Revenue Code	430
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: SELF PAY	$67.50

Other antepartum diagnoses with O.R. procedures with CC

Facility

$51,200.00

Service Code	MSDRG 818
Min. Negotiated Rate	$18,346.93
Max. Negotiated Rate	$20,385.48
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$20,385.48
Rate for Payer: American Health Plans Medicare Advantage	$20,385.48
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$20,385.48
Rate for Payer: CIGNA Medicare Advantage	$20,385.48
Rate for Payer: HealthChoice Utah Medicare Advantage	$20,385.48
Rate for Payer: Humana Medicare Advantage	$20,385.48
Rate for Payer: Medicare	$20,385.48
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$20,385.48
Rate for Payer: MOLINA MEDICARE	$20,385.48
Rate for Payer: Pacific Source Medicare Advantage	$20,385.48
Rate for Payer: Select Health Medicare Advantage	$20,385.48
Rate for Payer: SELF PAY	$25,600.00
Rate for Payer: Tricare West Military	$18,346.93

Other antepartum diagnoses with O.R. procedures with MCC

Facility

$51,200.00

Service Code	MSDRG 817
Min. Negotiated Rate	$18,346.93
Max. Negotiated Rate	$20,385.48
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$20,385.48
Rate for Payer: American Health Plans Medicare Advantage	$20,385.48
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$20,385.48
Rate for Payer: CIGNA Medicare Advantage	$20,385.48
Rate for Payer: HealthChoice Utah Medicare Advantage	$20,385.48
Rate for Payer: Humana Medicare Advantage	$20,385.48
Rate for Payer: Medicare	$20,385.48
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$20,385.48
Rate for Payer: MOLINA MEDICARE	$20,385.48
Rate for Payer: Pacific Source Medicare Advantage	$20,385.48
Rate for Payer: Select Health Medicare Advantage	$20,385.48
Rate for Payer: SELF PAY	$25,600.00
Rate for Payer: Tricare West Military	$18,346.93

Other antepartum diagnoses with O.R. procedures without CC/MCC

Facility

$51,200.00

Service Code	MSDRG 819
Min. Negotiated Rate	$18,346.93
Max. Negotiated Rate	$20,385.48
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$20,385.48
Rate for Payer: American Health Plans Medicare Advantage	$20,385.48
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$20,385.48
Rate for Payer: CIGNA Medicare Advantage	$20,385.48
Rate for Payer: HealthChoice Utah Medicare Advantage	$20,385.48
Rate for Payer: Humana Medicare Advantage	$20,385.48
Rate for Payer: Medicare	$20,385.48
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$20,385.48
Rate for Payer: MOLINA MEDICARE	$20,385.48
Rate for Payer: Pacific Source Medicare Advantage	$20,385.48
Rate for Payer: Select Health Medicare Advantage	$20,385.48
Rate for Payer: SELF PAY	$25,600.00
Rate for Payer: Tricare West Military	$18,346.93

Other antepartum diagnoses without O.R. procedures with CC

Facility

$51,200.00

Service Code	MSDRG 832
Min. Negotiated Rate	$18,346.93
Max. Negotiated Rate	$20,385.48
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$20,385.48
Rate for Payer: American Health Plans Medicare Advantage	$20,385.48
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$20,385.48
Rate for Payer: CIGNA Medicare Advantage	$20,385.48
Rate for Payer: HealthChoice Utah Medicare Advantage	$20,385.48
Rate for Payer: Humana Medicare Advantage	$20,385.48
Rate for Payer: Medicare	$20,385.48
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$20,385.48
Rate for Payer: MOLINA MEDICARE	$20,385.48
Rate for Payer: Pacific Source Medicare Advantage	$20,385.48
Rate for Payer: Select Health Medicare Advantage	$20,385.48
Rate for Payer: SELF PAY	$25,600.00
Rate for Payer: Tricare West Military	$18,346.93

Other antepartum diagnoses without O.R. procedures with MCC

Facility

$51,200.00

Service Code	MSDRG 831
Min. Negotiated Rate	$18,346.93
Max. Negotiated Rate	$20,385.48
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$20,385.48
Rate for Payer: American Health Plans Medicare Advantage	$20,385.48
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$20,385.48
Rate for Payer: CIGNA Medicare Advantage	$20,385.48
Rate for Payer: HealthChoice Utah Medicare Advantage	$20,385.48
Rate for Payer: Humana Medicare Advantage	$20,385.48
Rate for Payer: Medicare	$20,385.48
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$20,385.48
Rate for Payer: MOLINA MEDICARE	$20,385.48
Rate for Payer: Pacific Source Medicare Advantage	$20,385.48
Rate for Payer: Select Health Medicare Advantage	$20,385.48
Rate for Payer: SELF PAY	$25,600.00
Rate for Payer: Tricare West Military	$18,346.93

Other antepartum diagnoses without O.R. procedures without CC/MCC

Facility

$51,200.00

Service Code	MSDRG 833
Min. Negotiated Rate	$18,346.93
Max. Negotiated Rate	$20,385.48
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$20,385.48
Rate for Payer: American Health Plans Medicare Advantage	$20,385.48
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$20,385.48
Rate for Payer: CIGNA Medicare Advantage	$20,385.48
Rate for Payer: HealthChoice Utah Medicare Advantage	$20,385.48
Rate for Payer: Humana Medicare Advantage	$20,385.48
Rate for Payer: Medicare	$20,385.48
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$20,385.48
Rate for Payer: MOLINA MEDICARE	$20,385.48
Rate for Payer: Pacific Source Medicare Advantage	$20,385.48
Rate for Payer: Select Health Medicare Advantage	$20,385.48
Rate for Payer: SELF PAY	$25,600.00
Rate for Payer: Tricare West Military	$18,346.93

Other cardiothoracic procedures with MCC

Facility

$86,400.00

Service Code	MSDRG 228
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

Other cardiothoracic procedures without MCC

Facility

$86,400.00

Service Code	MSDRG 229
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

Other circulatory system diagnoses with CC

Facility

$57,600.00

Service Code	MSDRG 315
Min. Negotiated Rate	$22,934.67
Max. Negotiated Rate	$25,482.97
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$25,482.97
Rate for Payer: American Health Plans Medicare Advantage	$25,482.97
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$25,482.97
Rate for Payer: CIGNA Medicare Advantage	$25,482.97
Rate for Payer: HealthChoice Utah Medicare Advantage	$25,482.97
Rate for Payer: Humana Medicare Advantage	$25,482.97
Rate for Payer: Medicare	$25,482.97
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$25,482.97
Rate for Payer: MOLINA MEDICARE	$25,482.97
Rate for Payer: Pacific Source Medicare Advantage	$25,482.97
Rate for Payer: Select Health Medicare Advantage	$25,482.97
Rate for Payer: SELF PAY	$28,800.00
Rate for Payer: Tricare West Military	$22,934.67

Other circulatory system diagnoses with MCC

Facility

$73,600.00

Service Code	MSDRG 314
Min. Negotiated Rate	$36,006.31
Max. Negotiated Rate	$40,007.01
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$40,007.01
Rate for Payer: American Health Plans Medicare Advantage	$40,007.01
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$40,007.01
Rate for Payer: CIGNA Medicare Advantage	$40,007.01
Rate for Payer: HealthChoice Utah Medicare Advantage	$40,007.01
Rate for Payer: Humana Medicare Advantage	$40,007.01
Rate for Payer: Medicare	$40,007.01
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$40,007.01
Rate for Payer: MOLINA MEDICARE	$40,007.01
Rate for Payer: Pacific Source Medicare Advantage	$40,007.01
Rate for Payer: Select Health Medicare Advantage	$40,007.01
Rate for Payer: SELF PAY	$36,800.00
Rate for Payer: Tricare West Military	$36,006.31

Other circulatory system diagnoses without CC/MCC

Facility

$51,200.00

Service Code	MSDRG 316
Min. Negotiated Rate	$18,346.93
Max. Negotiated Rate	$20,385.48
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$20,385.48
Rate for Payer: American Health Plans Medicare Advantage	$20,385.48
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$20,385.48
Rate for Payer: CIGNA Medicare Advantage	$20,385.48
Rate for Payer: HealthChoice Utah Medicare Advantage	$20,385.48
Rate for Payer: Humana Medicare Advantage	$20,385.48
Rate for Payer: Medicare	$20,385.48
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$20,385.48
Rate for Payer: MOLINA MEDICARE	$20,385.48
Rate for Payer: Pacific Source Medicare Advantage	$20,385.48
Rate for Payer: Select Health Medicare Advantage	$20,385.48
Rate for Payer: SELF PAY	$25,600.00
Rate for Payer: Tricare West Military	$18,346.93

Other circulatory system O.R. procedures

Facility

$96,000.00

Service Code	MSDRG 264
Min. Negotiated Rate	$48,792.46
Max. Negotiated Rate	$54,213.85
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$54,213.85
Rate for Payer: American Health Plans Medicare Advantage	$54,213.85
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$54,213.85
Rate for Payer: CIGNA Medicare Advantage	$54,213.85
Rate for Payer: HealthChoice Utah Medicare Advantage	$54,213.85
Rate for Payer: Humana Medicare Advantage	$54,213.85
Rate for Payer: Medicare	$54,213.85
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$54,213.85
Rate for Payer: MOLINA MEDICARE	$54,213.85
Rate for Payer: Pacific Source Medicare Advantage	$54,213.85
Rate for Payer: Select Health Medicare Advantage	$54,213.85
Rate for Payer: SELF PAY	$48,000.00
Rate for Payer: Tricare West Military	$48,792.46

Other digestive system diagnoses with CC

Facility

$70,400.00

Service Code	MSDRG 394
Min. Negotiated Rate	$30,972.26
Max. Negotiated Rate	$34,413.62
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$34,413.62
Rate for Payer: American Health Plans Medicare Advantage	$34,413.62
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$34,413.62
Rate for Payer: CIGNA Medicare Advantage	$34,413.62
Rate for Payer: HealthChoice Utah Medicare Advantage	$34,413.62
Rate for Payer: Humana Medicare Advantage	$34,413.62
Rate for Payer: Medicare	$34,413.62
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$34,413.62
Rate for Payer: MOLINA MEDICARE	$34,413.62
Rate for Payer: Pacific Source Medicare Advantage	$34,413.62
Rate for Payer: Select Health Medicare Advantage	$34,413.62
Rate for Payer: SELF PAY	$35,200.00
Rate for Payer: Tricare West Military	$30,972.26

Other digestive system diagnoses with MCC

Facility

$86,400.00

Service Code	MSDRG 393
Min. Negotiated Rate	$45,358.70
Max. Negotiated Rate	$50,398.56
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$50,398.56
Rate for Payer: American Health Plans Medicare Advantage	$50,398.56
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$50,398.56
Rate for Payer: CIGNA Medicare Advantage	$50,398.56
Rate for Payer: HealthChoice Utah Medicare Advantage	$50,398.56
Rate for Payer: Humana Medicare Advantage	$50,398.56
Rate for Payer: Medicare	$50,398.56
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$50,398.56
Rate for Payer: MOLINA MEDICARE	$50,398.56
Rate for Payer: Pacific Source Medicare Advantage	$50,398.56
Rate for Payer: Select Health Medicare Advantage	$50,398.56
Rate for Payer: SELF PAY	$43,200.00
Rate for Payer: Tricare West Military	$45,358.70

Other digestive system diagnoses without CC/MCC

Facility

$51,200.00

Service Code	MSDRG 395
Min. Negotiated Rate	$18,346.93
Max. Negotiated Rate	$20,385.48
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$20,385.48
Rate for Payer: American Health Plans Medicare Advantage	$20,385.48
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$20,385.48
Rate for Payer: CIGNA Medicare Advantage	$20,385.48
Rate for Payer: HealthChoice Utah Medicare Advantage	$20,385.48
Rate for Payer: Humana Medicare Advantage	$20,385.48
Rate for Payer: Medicare	$20,385.48
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$20,385.48
Rate for Payer: MOLINA MEDICARE	$20,385.48
Rate for Payer: Pacific Source Medicare Advantage	$20,385.48
Rate for Payer: Select Health Medicare Advantage	$20,385.48
Rate for Payer: SELF PAY	$25,600.00
Rate for Payer: Tricare West Military	$18,346.93

Other digestive system O.R. procedures with CC*

Facility

$99,200.00

Service Code	MSDRG 357
Min. Negotiated Rate	$59,897.93
Max. Negotiated Rate	$66,553.26
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$66,553.26
Rate for Payer: American Health Plans Medicare Advantage	$66,553.26
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$66,553.26
Rate for Payer: CIGNA Medicare Advantage	$66,553.26
Rate for Payer: HealthChoice Utah Medicare Advantage	$66,553.26
Rate for Payer: Humana Medicare Advantage	$66,553.26
Rate for Payer: Medicare	$66,553.26
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$66,553.26
Rate for Payer: MOLINA MEDICARE	$66,553.26
Rate for Payer: Pacific Source Medicare Advantage	$66,553.26
Rate for Payer: Select Health Medicare Advantage	$66,553.26
Rate for Payer: SELF PAY	$49,600.00
Rate for Payer: Tricare West Military	$59,897.93

Other digestive system O.R. procedures with MCC*

Facility

$99,200.00

Service Code	MSDRG 356
Min. Negotiated Rate	$59,897.93
Max. Negotiated Rate	$66,553.26
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$66,553.26
Rate for Payer: American Health Plans Medicare Advantage	$66,553.26
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$66,553.26
Rate for Payer: CIGNA Medicare Advantage	$66,553.26
Rate for Payer: HealthChoice Utah Medicare Advantage	$66,553.26
Rate for Payer: Humana Medicare Advantage	$66,553.26
Rate for Payer: Medicare	$66,553.26
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$66,553.26
Rate for Payer: MOLINA MEDICARE	$66,553.26
Rate for Payer: Pacific Source Medicare Advantage	$66,553.26
Rate for Payer: Select Health Medicare Advantage	$66,553.26
Rate for Payer: SELF PAY	$49,600.00
Rate for Payer: Tricare West Military	$59,897.93

Other digestive system O.R. procedures without CC/MCC

Facility

$99,200.00

Service Code	MSDRG 358
Min. Negotiated Rate	$59,897.93
Max. Negotiated Rate	$66,553.26
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$66,553.26
Rate for Payer: American Health Plans Medicare Advantage	$66,553.26
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$66,553.26
Rate for Payer: CIGNA Medicare Advantage	$66,553.26
Rate for Payer: HealthChoice Utah Medicare Advantage	$66,553.26
Rate for Payer: Humana Medicare Advantage	$66,553.26
Rate for Payer: Medicare	$66,553.26
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$66,553.26
Rate for Payer: MOLINA MEDICARE	$66,553.26
Rate for Payer: Pacific Source Medicare Advantage	$66,553.26
Rate for Payer: Select Health Medicare Advantage	$66,553.26
Rate for Payer: SELF PAY	$49,600.00
Rate for Payer: Tricare West Military	$59,897.93

Other disorders of nervous system with CC

Facility

$67,200.00

Service Code	MSDRG 92
Min. Negotiated Rate	$28,266.26
Max. Negotiated Rate	$31,406.95
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$31,406.95
Rate for Payer: American Health Plans Medicare Advantage	$31,406.95
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$31,406.95
Rate for Payer: CIGNA Medicare Advantage	$31,406.95
Rate for Payer: HealthChoice Utah Medicare Advantage	$31,406.95
Rate for Payer: Humana Medicare Advantage	$31,406.95
Rate for Payer: Medicare	$31,406.95
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$31,406.95
Rate for Payer: MOLINA MEDICARE	$31,406.95
Rate for Payer: Pacific Source Medicare Advantage	$31,406.95
Rate for Payer: Select Health Medicare Advantage	$31,406.95
Rate for Payer: SELF PAY	$33,600.00
Rate for Payer: Tricare West Military	$28,266.26

Other disorders of nervous system with MCC

Facility

$76,800.00

Service Code	MSDRG 91
Min. Negotiated Rate	$35,817.33
Max. Negotiated Rate	$39,797.03
Rate for Payer: Pacific Source Medicare Advantage	$39,797.03
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$39,797.03
Rate for Payer: American Health Plans Medicare Advantage	$39,797.03
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$39,797.03
Rate for Payer: CIGNA Medicare Advantage	$39,797.03
Rate for Payer: HealthChoice Utah Medicare Advantage	$39,797.03
Rate for Payer: Humana Medicare Advantage	$39,797.03
Rate for Payer: Medicare	$39,797.03
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$39,797.03
Rate for Payer: MOLINA MEDICARE	$39,797.03
Rate for Payer: Select Health Medicare Advantage	$39,797.03
Rate for Payer: SELF PAY	$38,400.00
Rate for Payer: Tricare West Military	$35,817.33

Know your out-of-pocket cost for care.

All Charges