Western Peaks Specialty Hospital

All Charges

Charge

Type

Setting

Price

TEST LUNG

Facility

$30.02

Hospital Revenue Code	270
Min. Negotiated Rate	$15.01
Max. Negotiated Rate	$15.01
Rate for Payer: SELF PAY	$15.01

TEST LUNG INFANT

Facility

$19.06

Hospital Revenue Code	270
Min. Negotiated Rate	$9.53
Max. Negotiated Rate	$9.53
Rate for Payer: SELF PAY	$9.53

TEST LUNG WP

Facility

$30.02

Hospital Revenue Code	270
Min. Negotiated Rate	$15.01
Max. Negotiated Rate	$15.01
Rate for Payer: SELF PAY	$15.01

TESTOSTERONE TOTAL

Facility

$39.00

Service Code	CPT 84403
Hospital Revenue Code	300
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$19.50
Rate for Payer: SELF PAY	$19.50

TEST STRIP CONTROL SOLUTION (Q

Facility

$14.40

Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: SELF PAY	$7.20

TEST STRIPS (QUINTET)

Facility

$8.84

Hospital Revenue Code	270
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$4.42
Rate for Payer: SELF PAY	$4.42

TEST STRIPS (QUINTET) WP

Facility

$8.84

Hospital Revenue Code	270
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$4.42
Rate for Payer: SELF PAY	$4.42

THEOPHYLINE

Facility

$14.14

Service Code	CPT 80198
Hospital Revenue Code	300
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$7.07
Rate for Payer: SELF PAY	$7.07

Ther Act Dynam 1 unit

Facility

$51.00

Service Code	CPT 97530
Hospital Revenue Code	420
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: SELF PAY	$25.50

Therapeutic Activities-1

Facility

$51.00

Service Code	CPT 97530
Hospital Revenue Code	430
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: SELF PAY	$25.50

Therapeutic Activities-1

Facility

$46.58

Service Code	CPT 97530
Hospital Revenue Code	440
Min. Negotiated Rate	$23.29
Max. Negotiated Rate	$23.29
Rate for Payer: SELF PAY	$23.29

Ther Ex 1 unit

Facility

$47.00

Service Code	CPT 97110
Hospital Revenue Code	420
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$23.50
Rate for Payer: SELF PAY	$23.50

Therpeutic Exercises(1)

Facility

$91.06

Service Code	CPT 97110
Hospital Revenue Code	440
Min. Negotiated Rate	$45.53
Max. Negotiated Rate	$45.53
Rate for Payer: SELF PAY	$45.53

Therpeutic Exercises(15)

Facility

$47.00

Service Code	CPT 97110
Hospital Revenue Code	430
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$23.50
Rate for Payer: SELF PAY	$23.50

THROAT CULTURE

Facility

$19.00

Service Code	CPT 87070
Hospital Revenue Code	300
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$9.50
Rate for Payer: SELF PAY	$9.50

Thyroid, parathyroid and thyroglossal procedures with CC

Facility

$86,400.00

Service Code	MSDRG 626
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

Thyroid, parathyroid and thyroglossal procedures with MCC

Facility

$112,000.00

Service Code	MSDRG 625
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

Thyroid, parathyroid and thyroglossal procedures without CC/MCC

Facility

$51,200.00

Service Code	MSDRG 627
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

THYROID PROFILE

Facility

$14.78

Service Code	CPT 84442
Hospital Revenue Code	300
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$7.39
Rate for Payer: SELF PAY	$7.39

TIBC

Facility

$94.23

Service Code	CPT 83550
Hospital Revenue Code	300
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$47.12
Rate for Payer: SELF PAY	$47.12

TIBC 2

Facility

$94.23

Service Code	CPT 83550
Hospital Revenue Code	300
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$47.12
Rate for Payer: SELF PAY	$47.12

TISSUE

Facility

$1.28

Hospital Revenue Code	270
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.64
Rate for Payer: SELF PAY	$0.64

TISSUE WP

Facility

$1.28

Hospital Revenue Code	270
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.64
Rate for Payer: SELF PAY	$0.64

TOENAIL CLIPPER

Facility

$1.10

Hospital Revenue Code	270
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.55
Rate for Payer: SELF PAY	$0.55

TOENAIL CLIPPER WP

Facility

$1.10

Hospital Revenue Code	270
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$0.55
Rate for Payer: SELF PAY	$0.55

Know your out-of-pocket cost for care.

All Charges