Western Peaks Specialty Hospital

All Charges

Charge

Type

Setting

Price

Vapotherm Machine

Facility

$73.00

Hospital Revenue Code	290
Min. Negotiated Rate	$36.50
Max. Negotiated Rate	$36.50
Rate for Payer: SELF PAY	$36.50

VARICELLA ZOSTER IGG

Facility

$130.00

Service Code	CPT 86787
Hospital Revenue Code	300
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$65.00
Rate for Payer: SELF PAY	$65.00

VASELINE (PETROLEUM JELLY)

Facility

$0.10

Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: SELF PAY	$0.05

VASELINE (PETROLEUM JELLY) WP

Facility

$0.10

Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: SELF PAY	$0.05

Vein ligation and stripping

Facility

$96,000.00

Service Code	MSDRG 263
Min. Negotiated Rate	$48,792.46
Max. Negotiated Rate	$54,213.85
Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS	$54,213.85
Rate for Payer: American Health Plans Medicare Advantage	$54,213.85
Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage	$54,213.85
Rate for Payer: CIGNA Medicare Advantage	$54,213.85
Rate for Payer: HealthChoice Utah Medicare Advantage	$54,213.85
Rate for Payer: Humana Medicare Advantage	$54,213.85
Rate for Payer: Medicare	$54,213.85
Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL	$54,213.85
Rate for Payer: MOLINA MEDICARE	$54,213.85
Rate for Payer: Pacific Source Medicare Advantage	$54,213.85
Rate for Payer: Select Health Medicare Advantage	$54,213.85
Rate for Payer: SELF PAY	$48,000.00
Rate for Payer: Tricare West Military	$48,792.46

Vent Alarm - Remote

Facility

$3.38

Hospital Revenue Code	290
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: SELF PAY	$1.69

VENT CIR INFANT/NEO. DRY TUBE

Facility

$104.24

Hospital Revenue Code	270
Min. Negotiated Rate	$52.12
Max. Negotiated Rate	$52.12
Rate for Payer: SELF PAY	$52.12

VENT FILTER ESPIRIT WP

Facility

$20.98

Hospital Revenue Code	270
Min. Negotiated Rate	$10.49
Max. Negotiated Rate	$10.49
Rate for Payer: SELF PAY	$10.49

Ventilator - Drager Evita XL

Facility

$216.00

Hospital Revenue Code	290
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$108.00
Rate for Payer: SELF PAY	$108.00

Ventilator - Espirit

Facility

$140.00

Hospital Revenue Code	290
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$70.00
Rate for Payer: SELF PAY	$70.00

Ventilator - Trilogy

Facility

$74.00

Hospital Revenue Code	290
Min. Negotiated Rate	$37.00
Max. Negotiated Rate	$37.00
Rate for Payer: SELF PAY	$37.00

VENT PVC SLEEVE

Facility

$4.00

Hospital Revenue Code	270
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: SELF PAY	$2.00

Ventricular shunt procedures with CC

Facility

$112,000.00

Service Code	MSDRG 32
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

Ventricular shunt procedures with MCC

Facility

$112,000.00

Service Code	MSDRG 31
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

Ventricular shunt procedures without CC/MCC

Facility

$112,000.00

Service Code	MSDRG 33
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

Venus Uper and Lower EXTR

Facility

$700.00

Hospital Revenue Code	320
Min. Negotiated Rate	$350.00
Max. Negotiated Rate	$350.00
Rate for Payer: SELF PAY	$350.00

Viral illness with MCC

Facility

$86,400.00

Service Code	MSDRG 865
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

Viral illness without MCC

Facility

$51,200.00

Service Code	MSDRG 866
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

Viral meningitis with CC/MCC

Facility

$51,200.00

Service Code	MSDRG 75
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

Viral meningitis without CC/MCC

Facility

$51,200.00

Service Code	MSDRG 76
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

Visco Mattress

Facility

$10.00

Hospital Revenue Code	290
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: SELF PAY	$5.00

VITAL AF 1.2

Facility

$28.68

Hospital Revenue Code	270
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$14.34
Rate for Payer: SELF PAY	$14.34

Vital AF 1.2 8oz

Facility

$6.62

Hospital Revenue Code	270
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$3.31
Rate for Payer: SELF PAY	$3.31

VITAL AF 1.2 WP

Facility

$26.06

Hospital Revenue Code	270
Min. Negotiated Rate	$13.03
Max. Negotiated Rate	$13.03
Rate for Payer: SELF PAY	$13.03

VITAL AF 8OZ CARTON

Facility

$6.54

Hospital Revenue Code	270
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$3.27
Rate for Payer: SELF PAY	$3.27

Know your out-of-pocket cost for care.

All Charges