NOTICE REGARDING HEALTH CARE PLAN COVERAGE

This freestanding emergency department (Southwest 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.

Southwest Emergency Department

Updated August 3, 2022

CPT Code Charge Description Average Charge per Account
99284 LVL 4 FREE STD EMER DEPT $9,279
85027 COMPLETE CBC AUTOMATED $275
99283 LVL 3 FREE STD EMER DEPT $5,537
80053 COMPREHEN METABOLIC PANEL $929
96374 THER/PROPH/DIAG INJ IV PUSH $706
93005 ELECTROCARDIOGRAM TRACING $1,074
84484 ASSAY OF TROPONIN QUANT $904
71045 X-RAY EXAM CHEST 1 VIEW $1,488
96375 TX/PRO/DX INJ NEW DRUG ADDON $727
81003 URINALYSIS AUTO W/O SCOPE $268
80048 METABOLIC PANEL TOTAL CA $761
83690 ASSAY OF LIPASE $605
99282 LVL 2 FREE STD EMER DEPT $2,438
84703 CHORIONIC GONADOTROPIN ASSAY $408
87804 INFLUENZA ASSAY W/OPTIC $267
74177 CT ABD & PELV W/CONTRAST $13,571
81001 URINALYSIS AUTO W/SCOPE $418
70450 CT HEAD/BRAIN W/O DYE $6,405
96361 HYDRATE IV INFUSION ADD-ON $683
85379 FIBRIN DEGRADATION QUANT $1,089
99281 LVL 1 FREE STD EMER DEPT $1,003
87426 SARSCOV CORONAVIRUS AG IA $70
96372 THER/PROPH/DIAG INJ SC/IM $429
36415 ROUTINE VENIPUNCTURE $98
90471 IMMUNIZATION ADMIN $72
Freestanding Emergency Facility Fees
CPT Code Charge Description Average charge per account
99281 LVL 1 FREE STD EMER DEPT $1,003
99282 LVL 2 FREE STD EMER DEPT $2,438
99283 LVL 3 FREE STD EMER DEPT $5,537
99284 LVL 4 FREE STD EMER DEPT $9,279
99285 LVL 5 FREE STD EMER DEPT $15,573

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