Western Peaks Specialty Hospital

All Charges

Charge

Type

Setting

Price

R-TRACH BIVONA KID 4.0 PED (CU

Facility

$383.30

Hospital Revenue Code	270
Min. Negotiated Rate	$191.65
Max. Negotiated Rate	$191.65
Rate for Payer: SELF PAY	$191.65

R-TRACH BIVONA KID 4.0 PED(cuf

Facility

$113.00

Hospital Revenue Code	270
Min. Negotiated Rate	$56.50
Max. Negotiated Rate	$56.50
Rate for Payer: SELF PAY	$56.50

R-TRACH BIVONA KID 4.0 PED(FLE

Facility

$184.00

Hospital Revenue Code	270
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$92.00
Rate for Payer: SELF PAY	$92.00

R-TRACH BIVONA KID 4.5 PED (cu

Facility

$452.82

Hospital Revenue Code	270
Min. Negotiated Rate	$226.41
Max. Negotiated Rate	$226.41
Rate for Payer: SELF PAY	$226.41

R-TRACH BIVONA KID 4.5 PED(FLE

Facility

$184.00

Hospital Revenue Code	270
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$92.00
Rate for Payer: SELF PAY	$92.00

R-TRACH BIVONA KID 5.0 PED FLE

Facility

$322.70

Hospital Revenue Code	270
Min. Negotiated Rate	$161.35
Max. Negotiated Rate	$161.35
Rate for Payer: SELF PAY	$161.35

R-TRACH BIVONA KID 5.5 PED(FLE

Facility

$336.00

Hospital Revenue Code	270
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$168.00
Rate for Payer: SELF PAY	$168.00

R-TRACH SHILEY 4.0 PED

Facility

$66.64

Hospital Revenue Code	270
Min. Negotiated Rate	$33.32
Max. Negotiated Rate	$33.32
Rate for Payer: SELF PAY	$33.32

R-TRACH SHILEY 5 XLTCP

Facility

$152.56

Hospital Revenue Code	270
Min. Negotiated Rate	$76.28
Max. Negotiated Rate	$76.28
Rate for Payer: SELF PAY	$76.28

R-TRACH SHILEY 5 XLTCP WP

Facility

$152.56

Hospital Revenue Code	270
Min. Negotiated Rate	$76.28
Max. Negotiated Rate	$76.28
Rate for Payer: SELF PAY	$76.28

R-TRACH SHILEY 5 XLT CUFFLESS

Facility

$140.56

Hospital Revenue Code	270
Min. Negotiated Rate	$70.28
Max. Negotiated Rate	$70.28
Rate for Payer: SELF PAY	$70.28

R-TRACH SHILEY 6 SCT

Facility

$64.28

Hospital Revenue Code	270
Min. Negotiated Rate	$32.14
Max. Negotiated Rate	$32.14
Rate for Payer: SELF PAY	$32.14

R-TRACH SHILEY 6 SCT WP

Facility

$64.28

Hospital Revenue Code	270
Min. Negotiated Rate	$32.14
Max. Negotiated Rate	$32.14
Rate for Payer: SELF PAY	$32.14

R-TRACH SHILEY 6 XLTCD

Facility

$160.74

Hospital Revenue Code	270
Min. Negotiated Rate	$80.37
Max. Negotiated Rate	$80.37
Rate for Payer: SELF PAY	$80.37

R-TRACH SHILEY 6 XLTCP

Facility

$147.36

Hospital Revenue Code	270
Min. Negotiated Rate	$73.68
Max. Negotiated Rate	$73.68
Rate for Payer: SELF PAY	$73.68

R-TRACH SHILEY 6 XLTCP WP

Facility

$147.36

Hospital Revenue Code	270
Min. Negotiated Rate	$73.68
Max. Negotiated Rate	$73.68
Rate for Payer: SELF PAY	$73.68

R-TRACH SHILEY 6 XLT CUFFLESS

Facility

$140.56

Hospital Revenue Code	270
Min. Negotiated Rate	$70.28
Max. Negotiated Rate	$70.28
Rate for Payer: SELF PAY	$70.28

R-TRACH SHILEY 70XLTCD WP

Facility

$163.84

Hospital Revenue Code	270
Min. Negotiated Rate	$81.92
Max. Negotiated Rate	$81.92
Rate for Payer: SELF PAY	$81.92

R-TRACH SHILEY 7 SCT WP

Facility

$64.36

Hospital Revenue Code	270
Min. Negotiated Rate	$32.18
Max. Negotiated Rate	$32.18
Rate for Payer: SELF PAY	$32.18

R-TRACH SHILEY 7 XLTCP

Facility

$163.84

Hospital Revenue Code	270
Min. Negotiated Rate	$81.92
Max. Negotiated Rate	$81.92
Rate for Payer: SELF PAY	$81.92

R-TRACH SHILEY 7 XLTCP WP

Facility

$163.84

Hospital Revenue Code	270
Min. Negotiated Rate	$81.92
Max. Negotiated Rate	$81.92
Rate for Payer: SELF PAY	$81.92

R-TRACH SHILEY 7 XLT CUFFLESS

Facility

$140.56

Hospital Revenue Code	270
Min. Negotiated Rate	$70.28
Max. Negotiated Rate	$70.28
Rate for Payer: SELF PAY	$70.28

R-TRACH SHILEY 8 SCT

Facility

$64.36

Hospital Revenue Code	270
Min. Negotiated Rate	$32.18
Max. Negotiated Rate	$32.18
Rate for Payer: SELF PAY	$32.18

R-TRACH SHILEY 8 SCT WP

Facility

$64.36

Hospital Revenue Code	270
Min. Negotiated Rate	$32.18
Max. Negotiated Rate	$32.18
Rate for Payer: SELF PAY	$32.18

R-TRACH SHILEY 8 XLTCD

Facility

$163.84

Hospital Revenue Code	270
Min. Negotiated Rate	$81.92
Max. Negotiated Rate	$81.92
Rate for Payer: SELF PAY	$81.92

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All Charges