Western Peaks Specialty Hospital

All Charges

Charge

Type

Setting

Price

TRACH PORTEX 8.0 MM

Facility

$72.46

Hospital Revenue Code	270
Min. Negotiated Rate	$36.23
Max. Negotiated Rate	$36.23
Rate for Payer: SELF PAY	$36.23

TRACH PORTEX 9.0 MM

Facility

$60.00

Hospital Revenue Code	270
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: SELF PAY	$30.00

TRACH REPAIR KIT

Facility

$18.40

Hospital Revenue Code	270
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$9.20
Rate for Payer: SELF PAY	$9.20

TRACH REPAIR KIT WP

Facility

$18.40

Hospital Revenue Code	270
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$9.20
Rate for Payer: SELF PAY	$9.20

TRACH SHILEY 3.5 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

TRACH SHILEY 3.5 PED

Facility

$64.52

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

TRACH SHILEY 4.0 NEO NATAL

Facility

$66.64

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

TRACH SHILEY 4 DCFS

Facility

$71.02

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

TRACH SHILEY 4DCT

Facility

$81.50

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

TRACH SHILEY 5.5 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

TRACH SHILEY 5 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

TRACH SHILEY 6 DCFS

Facility

$71.02

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

TRACH SHILEY 6 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

TRACH SHILEY 6 DFEN

Facility

$89.54

Hospital Revenue Code	270
Min. Negotiated Rate	$44.77
Max. Negotiated Rate	$44.77
Rate for Payer: SELF PAY	$44.77

TRACH SHILEY 7 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

TRACH SHILEY 8 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

TRACH, SHILEY 8DFEN

Facility

$89.54

Hospital Revenue Code	270
Min. Negotiated Rate	$44.77
Max. Negotiated Rate	$44.77
Rate for Payer: SELF PAY	$44.77

TRACH SHILEY 9 SCT

Facility

$62.04

Hospital Revenue Code	270
Min. Negotiated Rate	$31.02
Max. Negotiated Rate	$31.02
Rate for Payer: SELF PAY	$31.02

TRACH SHILEY CUFFLESS PED XLNG

Facility

$78.20

Hospital Revenue Code	270
Min. Negotiated Rate	$39.10
Max. Negotiated Rate	$39.10
Rate for Payer: SELF PAY	$39.10

TRACH SHILEY KID 5.5 PELF

Facility

$127.36

Hospital Revenue Code	270
Min. Negotiated Rate	$63.68
Max. Negotiated Rate	$63.68
Rate for Payer: SELF PAY	$63.68

TRACH TAPERED SHILEY CUFFED 4C

Facility

$106.26

Hospital Revenue Code	270
Min. Negotiated Rate	$53.13
Max. Negotiated Rate	$53.13
Rate for Payer: SELF PAY	$53.13

TRACH TAPERED SHILEY CUFFED 5C

Facility

$111.08

Hospital Revenue Code	270
Min. Negotiated Rate	$55.54
Max. Negotiated Rate	$55.54
Rate for Payer: SELF PAY	$55.54

TRACH TAPERED SHILEY CUFFED 6C

Facility

$111.58

Hospital Revenue Code	270
Min. Negotiated Rate	$55.79
Max. Negotiated Rate	$55.79
Rate for Payer: SELF PAY	$55.79

TRACH TAPERED SHILEY CUFFED 8C

Facility

$106.26

Hospital Revenue Code	270
Min. Negotiated Rate	$53.13
Max. Negotiated Rate	$53.13
Rate for Payer: SELF PAY	$53.13

TRACH TAPERED SHILEY UNCUFFED

Facility

$90.26

Hospital Revenue Code	270
Min. Negotiated Rate	$45.13
Max. Negotiated Rate	$45.13
Rate for Payer: SELF PAY	$45.13
Rate for Payer: SELF PAY	$48.14

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All Charges