NOTICE REGARDING HEALTH CARE PLAN COVERAGE

This freestanding emergency department (Northeast Emergency Department ) accepts patients enrolled in the following programs: Colorado Medicaid (Articles 4, 5 and 6 of Title 25.5); Medicare (Title XVIII of the Federal Social Security Act, as amended); the CHIP program (Article 8 of Title 25.5) and a military health plan (10 U.S.C. Section 1071).

The prices listed on this facility’s chargemaster or fee schedule for any given health care service is the maximum charge that any patient will be billed for the service. The actual price for the health care service may be lower depending on your health insurance benefits and the availability of discounts or financial assistance.

This Facility will charge a facility fee. In addition to facility fees, you will be charged for any testing, supplies, or other services you receive. All physicians providing health care services will bill separately from the Facility for services they provided to you.

The health care provider networks and carriers that this Facility participates with are listed here.

This Facility and/or a physician providing health care services may not be a participating provider in your health insurance provider network.

If you are covered by health insurance, you are strongly encouraged to consult with your health insurer to determine accurate information about your financial responsibility for a particular health care service provided at this Facility. If you are not covered by health insurance, you are strongly encouraged to contact (866) 475-2403 to discuss payment options and the availability of financial assistance prior to receiving a health care service from this Facility.

The average fee schedule price for the twenty-five most common health care services provided by this Facility are listed below. The prices listed for each health care service is the average charge that you may be billed for the particular service. The actual price for the health care service may be lower depending on your insurance coverage and the availability of discounts or financial assistance.

Northeast Emergency Department

Updated October 13, 2022

CPT Code Charge Description Average Charge per Account
99284 LVL 4 FREE STD EMER DEPT $11,516
96374 THER/PROPH/DIAG INJ IV PUSH $621
80053 COMPREHEN METABOLIC PANEL $1,799
81003 URINALYSIS AUTO W/O SCOPE $410
85027 COMPLETE CBC AUTOMATED $693
71045 X-RAY EXAM CHEST 1 VIEW $962
93005 ELECTROCARDIOGRAM TRACING $2,093
84703 CHORIONIC GONADOTROPIN ASSAY $811
80047 METABOLIC PANEL IONIZED CA $1,096
99282 LVL 2 FREE STD EMER DEPT $3,026
84484 ASSAY OF TROPONIN QUANT $1,111
96375 TX/PRO/DX INJ NEW DRUG ADDON $621
85014 HEMATOCRIT $242
96361 HYDRATE IV INFUSION ADD-ON $318
87635 SARS-COV-2 COVID-19 AMP PRB $92
74177 CT ABD & PELV W/CONTRAST $21,074
87430 STREP A AG IA $559
87081 CULTURE SCREEN ONLY $478
99281 LVL 1 FREE STD EMER DEPT $1,244
96372 THER/PROPH/DIAG INJ SC/IM $650
70450 CT HEAD/BRAIN W/O DYE $11,964
83605 ASSAY OF LACTIC ACID $767
99285 LVL 5 FREE STD EMER DEPT $13,769
94640 AIRWAY INHALATION TREATMENT $250
Freestanding Emergency Facility Fees
CPT Code Charge Description Average Charge per Account
99281 LVL 1 FREE STD EMER DEPT $1,244
99282 LVL 2 FREE STD EMER DEPT $3,026
99283 LVL 3 FREE STD EMER DEPT $6,872
99284 LVL 4 FREE STD EMER DEPT $11,516
99285 LVL 5 FREE STD EMER DEPT $13,769

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