Western Peaks Specialty Hospital

All Charges

Charge

Type

Setting

Price

VAC VERAFLO CLEANSE CHOICE DRE

Facility

$843.56

Hospital Revenue Code	270
Min. Negotiated Rate	$421.78
Max. Negotiated Rate	$421.78
Rate for Payer: SELF PAY	$421.78

VAC VERALINK CASSETTE

Facility

$156.54

Hospital Revenue Code	270
Min. Negotiated Rate	$78.27
Max. Negotiated Rate	$78.27
Rate for Payer: SELF PAY	$78.27

VAC VERALINK CASSETTE WP

Facility

$156.54

Hospital Revenue Code	270
Min. Negotiated Rate	$78.27
Max. Negotiated Rate	$78.27
Rate for Payer: SELF PAY	$78.27

VAC WHITE FOAM SMALL

Facility

$25.54

Hospital Revenue Code	270
Min. Negotiated Rate	$12.77
Max. Negotiated Rate	$12.77
Rate for Payer: SELF PAY	$12.77

VAC WHITE FOAM SMALL WP

Facility

$25.54

Hospital Revenue Code	270
Min. Negotiated Rate	$12.77
Max. Negotiated Rate	$12.77
Rate for Payer: SELF PAY	$12.77

VAC Y CONNECTOR

Facility

$13.70

Hospital Revenue Code	270
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$6.85
Rate for Payer: SELF PAY	$6.85

VAC Y CONNECTOR WP

Facility

$13.70

Hospital Revenue Code	270
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$6.85
Rate for Payer: SELF PAY	$6.85

Vagina, cervix and vulva procedures with CC/MCC

Facility

$112,000.00

Service Code	MSDRG 746
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

Vagina, cervix and vulva procedures without CC/MCC

Facility

$112,000.00

Service Code	MSDRG 747
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

Vaginal delivery with O.R. procedures except sterilization and/or D&C

Facility

$86,400.00

Service Code	MSDRG 768
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

Vaginal delivery without sterilization or D&C with CC

Facility

$70,400.00

Service Code	MSDRG 806
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

Vaginal delivery without sterilization or D&C with MCC

Facility

$70,400.00

Service Code	MSDRG 805
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

Vaginal delivery without sterilization or D&C without CC/MCC

Facility

$70,400.00

Service Code	MSDRG 807
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

Vaginal delivery with sterilization and/or D&C with CC

Facility

$86,400.00

Service Code	MSDRG 797
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

Vaginal delivery with sterilization and/or D&C with MCC

Facility

$86,400.00

Service Code	MSDRG 796
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

Vaginal delivery with sterilization and/or D&C without CC/MCC

Facility

$86,400.00

Service Code	MSDRG 798
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

VALPROIC ACID

Facility

$203.82

Service Code	CPT 80164
Hospital Revenue Code	300
Min. Negotiated Rate	$101.91
Max. Negotiated Rate	$101.91
Rate for Payer: SELF PAY	$101.91

VANCOMYCIN

Facility

$141.54

Service Code	CPT 80202
Hospital Revenue Code	300
Min. Negotiated Rate	$70.77
Max. Negotiated Rate	$70.77
Rate for Payer: SELF PAY	$70.77

VANCO PEAK

Facility

$141.54

Service Code	CPT 80202
Hospital Revenue Code	300
Min. Negotiated Rate	$70.77
Max. Negotiated Rate	$70.77
Rate for Payer: SELF PAY	$70.77

VANCO PEAK 80202

Facility

$141.54

Service Code	CPT 80202
Hospital Revenue Code	300
Min. Negotiated Rate	$70.77
Max. Negotiated Rate	$70.77
Rate for Payer: SELF PAY	$70.77

VANCO TROUGH

Facility

$141.54

Service Code	CPT 80202
Hospital Revenue Code	300
Min. Negotiated Rate	$70.77
Max. Negotiated Rate	$70.77
Rate for Payer: SELF PAY	$70.77

VANCO TROUGH 80202

Facility

$141.54

Service Code	CPT 80202
Hospital Revenue Code	300
Min. Negotiated Rate	$70.77
Max. Negotiated Rate	$70.77
Rate for Payer: SELF PAY	$70.77

VAPOTHERM CANNULA, HIGH FLOW

Facility

$6.40

Hospital Revenue Code	270
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$3.20
Rate for Payer: SELF PAY	$3.20

VAPOTHERM CIRCUIT, HIGH FLOW

Facility

$192.00

Hospital Revenue Code	270
Min. Negotiated Rate	$96.00
Max. Negotiated Rate	$96.00
Rate for Payer: SELF PAY	$96.00

VAPOTHERM CIRCUIT, LOW FLOW

Facility

$192.00

Hospital Revenue Code	270
Min. Negotiated Rate	$96.00
Max. Negotiated Rate	$96.00
Rate for Payer: SELF PAY	$96.00

Know your out-of-pocket cost for care.

All Charges