Western Peaks Specialty Hospital

All Charges

Charge

Type

Setting

Price

R-TRACH SHILEY 8 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 8 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 8 XLT CUFFLESS

Facility

$173.74

Hospital Revenue Code	270
Min. Negotiated Rate	$86.87
Max. Negotiated Rate	$86.87
Rate for Payer: SELF PAY	$86.87

R-TRACH SHILEY ADULT 10 DCT

Facility

$81.50

Hospital Revenue Code	270
Min. Negotiated Rate	$40.75
Max. Negotiated Rate	$40.75
Rate for Payer: SELF PAY	$40.75

R-TRACH SHILEY ADULT 4 DCFS WP

Facility

$71.02

Hospital Revenue Code	270
Min. Negotiated Rate	$35.51
Max. Negotiated Rate	$35.51
Rate for Payer: SELF PAY	$35.51

R-TRACH SHILEY ADULT 4 DCT WP

Facility

$81.50

Hospital Revenue Code	270
Min. Negotiated Rate	$40.75
Max. Negotiated Rate	$40.75
Rate for Payer: SELF PAY	$40.75

R-TRACH SHILEY ADULT 6 DCFS WP

Facility

$71.02

Hospital Revenue Code	270
Min. Negotiated Rate	$35.51
Max. Negotiated Rate	$35.51
Rate for Payer: SELF PAY	$35.51

R-TRACH SHILEY ADULT 6 DCT WP

Facility

$81.50

Hospital Revenue Code	270
Min. Negotiated Rate	$40.75
Max. Negotiated Rate	$40.75
Rate for Payer: SELF PAY	$40.75

R-TRACH SHILEY ADULT 8 DCFS

Facility

$73.32

Hospital Revenue Code	270
Min. Negotiated Rate	$36.66
Max. Negotiated Rate	$36.66
Rate for Payer: SELF PAY	$36.66

R-TRACH SHILEY ADULT 8 DCFS WP

Facility

$73.32

Hospital Revenue Code	270
Min. Negotiated Rate	$36.66
Max. Negotiated Rate	$36.66
Rate for Payer: SELF PAY	$36.66

R-TRACH SHILEY ADULT 8 DCT WP

Facility

$81.50

Hospital Revenue Code	270
Min. Negotiated Rate	$40.75
Max. Negotiated Rate	$40.75
Rate for Payer: SELF PAY	$40.75

R-TRACH SHILEY KID 3.0 NEO

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 KID 3.0 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 KID 4.5 NEO

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 KID 4.5 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 KID 5.0 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 KID 5.5 PDL

Facility

$64.52

Hospital Revenue Code	270
Min. Negotiated Rate	$32.26
Max. Negotiated Rate	$32.26
Rate for Payer: SELF PAY	$32.26

R-TRACH SHILEY KID 6.5 PDL

Facility

$77.64

Hospital Revenue Code	270
Min. Negotiated Rate	$38.82
Max. Negotiated Rate	$38.82
Rate for Payer: SELF PAY	$38.82

RT-Serv High L8

Facility

$240.00

Hospital Revenue Code	410
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: SELF PAY	$120.00

RT-Serv Low L7

Facility

$120.00

Hospital Revenue Code	410
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: SELF PAY	$60.00

RT-Trach High Serv L4

Facility

$960.00

Hospital Revenue Code	410
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$480.00
Rate for Payer: SELF PAY	$480.00

RT-Trach Low Serv L5

Facility

$560.00

Hospital Revenue Code	410
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$280.00
Rate for Payer: SELF PAY	$280.00

RT-Trach Wein Serv L6

Facility

$1,248.00

Hospital Revenue Code	410
Min. Negotiated Rate	$624.00
Max. Negotiated Rate	$624.00
Rate for Payer: SELF PAY	$624.00

RT-Vent High Serv L1

Facility

$1,440.00

Hospital Revenue Code	410
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$720.00
Rate for Payer: SELF PAY	$720.00

RT-Vent Low Serv L2

Facility

$840.00

Hospital Revenue Code	410
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: SELF PAY	$420.00

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All Charges