NOTICE REGARDING HEALTH CARE PLAN COVERAGE

This freestanding emergency department (South Parker 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) 475-1385 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.

South Parker Emergency Department

Updated October 13, 2022

CPT Code Charge Description Average Charge per Account
99284 LVL 4 FREE STD EMER DEPT $10,909
99283 LVL 3 FREE STD EMER DEPT $6,509
85027 COMPLETE CBC AUTOMATED $541
87635 SARS-COV-2 COVID-19 AMP PRB $90
84703 CHORIONIC GONADOTROPIN ASSAY $492
82150 ASSAY OF AMYLASE $755
99282 LVL 2 FREE STD EMER DEPT $2,867
74177 CT ABD & PELV W/CONTRAST $16,282
96361 HYDRATE IV INFUSION ADD-ON $1,187
87804 INFLUENZA ASSAY W/OPTIC $590
99281 LVL 1 FREE STD EMER DEPT $1,180
70450 CT HEAD/BRAIN W/O DYE $14,063
85379 FIBRIN DEGRADATION QUANT $1,040
83605 ASSAY OF LACTIC ACID $576
96372 THER/PROPH/DIAG INJ SC/IM $436
90715 TDAP VACCINE 7 YRS/> IM $995
72125 CT NECK SPINE W/O DYE $14,063
96374 THER/PROPH/DIAG INJ IV PUSH $453
80047 METABOLIC PANEL IONIZED CA $1,175
93005 ELECTROCARDIOGRAM TRACING $1,351
96375 TX/PRO/DX INJ NEW DRUG ADDON $453
81003 URINALYSIS AUTO W/O SCOPE $373
80053 COMPREHEN METABOLIC PANEL $1,263
71045 X-RAY EXAM CHEST 1 VIEW $1,269
84484 ASSAY OF TROPONIN QUANT $1,078
Freestanding Emergency Facility Fees
CPT Code Charge Description Average Charge per Account
99281 LVL 1 FREE STD EMER DEPT $1,180
99282 LVL 2 FREE STD EMER DEPT $2,867
99283 LVL 3 FREE STD EMER DEPT $6,509
99284 LVL 4 FREE STD EMER DEPT $10,909
99285 LVL 5 FREE STD EMER DEPT $17,730

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