Western Peaks Specialty Hospital

All Charges

Charge

Type

Setting

Price

PADDED HAND MITTEN

Facility

$65.64

Hospital Revenue Code	270
Min. Negotiated Rate	$32.82
Max. Negotiated Rate	$32.82
Rate for Payer: SELF PAY	$32.82

Pancreas, liver and shunt procedures with CC

Facility

$51,200.00

Service Code	MSDRG 406
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

Pancreas, liver and shunt procedures with MCC

Facility

$112,000.00

Service Code	MSDRG 405
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

Pancreas, liver and shunt procedures without CC/MCC

Facility

$51,200.00

Service Code	MSDRG 407
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

PARATHYROID HORMONE

Facility

$79.00

Service Code	CPT 83970
Hospital Revenue Code	300
Min. Negotiated Rate	$39.50
Max. Negotiated Rate	$39.50
Rate for Payer: SELF PAY	$39.50

PARATHYROID HORMONE INTACT

Facility

$79.00

Service Code	CPT 83970
Hospital Revenue Code	300
Min. Negotiated Rate	$39.50
Max. Negotiated Rate	$39.50
Rate for Payer: SELF PAY	$39.50

PASSIVE CIRCUIT PED W/WATERTRA

Facility

$55.00

Hospital Revenue Code	270
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$27.50
Rate for Payer: SELF PAY	$27.50

PASSY MUIR SPEAKING VALVE (AQU

Facility

$153.34

Hospital Revenue Code	270
Min. Negotiated Rate	$76.67
Max. Negotiated Rate	$76.67
Rate for Payer: SELF PAY	$76.67

PASSY MUIR SPEAKING VALVE (PUR

Facility

$151.72

Hospital Revenue Code	270
Min. Negotiated Rate	$75.86
Max. Negotiated Rate	$75.86
Rate for Payer: SELF PAY	$75.86

Pathological fractures and musculoskeletal and connective tissue malignancy with CC*

Facility

$70,400.00

Service Code	MSDRG 543
Min. Negotiated Rate	$31,579.40
Max. Negotiated Rate	$35,088.22
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$35,088.22
Rate for Payer: American Health Plans Medicare Advantage	$35,088.22
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$35,088.22
Rate for Payer: CIGNA Medicare Advantage	$35,088.22
Rate for Payer: HealthChoice Utah Medicare Advantage	$35,088.22
Rate for Payer: Humana Medicare Advantage	$35,088.22
Rate for Payer: Medicare	$35,088.22
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$35,088.22
Rate for Payer: MOLINA MEDICARE	$35,088.22
Rate for Payer: Pacific Source Medicare Advantage	$35,088.22
Rate for Payer: Select Health Medicare Advantage	$35,088.22
Rate for Payer: SELF PAY	$35,200.00
Rate for Payer: Tricare West Military	$31,579.40

Pathological fractures and musculoskeletal and connective tissue malignancy with MCC*

Facility

$70,400.00

Service Code	MSDRG 542
Min. Negotiated Rate	$31,579.40
Max. Negotiated Rate	$35,088.22
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$35,088.22
Rate for Payer: American Health Plans Medicare Advantage	$35,088.22
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$35,088.22
Rate for Payer: CIGNA Medicare Advantage	$35,088.22
Rate for Payer: HealthChoice Utah Medicare Advantage	$35,088.22
Rate for Payer: Humana Medicare Advantage	$35,088.22
Rate for Payer: Medicare	$35,088.22
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$35,088.22
Rate for Payer: MOLINA MEDICARE	$35,088.22
Rate for Payer: Pacific Source Medicare Advantage	$35,088.22
Rate for Payer: Select Health Medicare Advantage	$35,088.22
Rate for Payer: SELF PAY	$35,200.00
Rate for Payer: Tricare West Military	$31,579.40

Pathological fractures and musculoskeletal and connective tissue malignancy without CC/MCC

Facility

$51,200.00

Service Code	MSDRG 544
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

Patient Auto Rotation Bed

Facility

$57.75

Hospital Revenue Code	290
Min. Negotiated Rate	$28.88
Max. Negotiated Rate	$28.88
Rate for Payer: SELF PAY	$28.88

PEAK FLOWMETER

Facility

$31.80

Hospital Revenue Code	270
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: SELF PAY	$15.90

PED ABD BINDER

Facility

$17.74

Hospital Revenue Code	270
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$8.87
Rate for Payer: SELF PAY	$8.87

PEDIALYTE

Facility

$11.28

Hospital Revenue Code	270
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$5.64
Rate for Payer: SELF PAY	$5.64

PEDIALYTE WP

Facility

$11.28

Hospital Revenue Code	270
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$5.64
Rate for Payer: SELF PAY	$5.64

PEDIASURE HARVEST

Facility

$4.20

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

PEDIASURE HARVEST 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

PEDIASURE PEPTIDE

Facility

$6.28

Hospital Revenue Code	270
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$3.14
Rate for Payer: SELF PAY	$3.14

PEDIASURE REDUCED CAL.

Facility

$0.68

Hospital Revenue Code	270
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.34
Rate for Payer: SELF PAY	$0.34

PEDIASURE W/FIBER 1.0

Facility

$0.76

Hospital Revenue Code	270
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: SELF PAY	$0.38

PEDIASURE W/FIBER 1.5

Facility

$4.90

Hospital Revenue Code	270
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$2.45
Rate for Payer: SELF PAY	$2.45

Pediasure with Fiber

Facility

$0.76

Hospital Revenue Code	270
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: SELF PAY	$0.38

PEDIATRIC PEPTIDE 1.5

Facility

$12.76

Hospital Revenue Code	270
Min. Negotiated Rate	$6.38
Max. Negotiated Rate	$6.38
Rate for Payer: SELF PAY	$6.38

Know your out-of-pocket cost for care.

All Charges