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 with prices ranging approximately and, on average, from $949 to $14,263. In addition to these 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 on the attached Exhibit 1.
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 on the attached Exhibit 2. 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 January 11, 2021
| South Parker Emergency Department | Average charge per account |
|---|---|
| Normal saline 50ml | $24 |
| Complete panel of 14 blood tests | $996 |
| Single or first dose of medication IV | $312 |
| Catheter needle used to start IV | $27 |
| 1000 ML bag of saline IV fluid | $492 |
| Normal saline 1000ml | $53 |
| Each additional hour of IV fluid hydration | $980 |
| Second or each additional dose of medication delivered via IV | $452 |
| 30mg injection of Ketorolac, a non-steroid anti-inflammatory medication | $284 |
| External recording of electrical activity of heart | $1,087 |
| IBUPROFEN 600MG TAB | $38 |
| Basic metabolic panel with ionized calcium | $943 |
| Urine test conducted via machine without micro | $293 |
| Blood test for pregnancy | $369 |
| 4mg vial of Ondansetron, used to prevent nausea and vomiting | $257 |
| Acetamin 500 mg | $72 |
| Computerized tomography "cat scan" of the abdomen and pelvis with contrast | $11,685 |
| ED PROC CAT 2 | $2,413 |
| Blood test for heart muscle | $963 |
| Chest x-ray with one view | $913 |
| Culture for group A strep | $122 |
| Chest x-ray with two views | $1,397 |
| Low osmolar contrast material used in diagnostic radiology | $1,477 |
| Lab test for serum amlyase | $539 |
| Sodium chloride .9 injection | $13 |