NOTICE REGARDING HEALTH CARE PLAN COVERAGE

This freestanding emergency department (Wesley 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 $851.00 to $6,898.00. 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 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.

Wesley Emergency Department

Updated May 31, 2022

Charge Code Charge Description Count of Accts Current Price
75010 LVL 3 FREE STD EMER DEPT 13,931 $3,135.00
75011 LVL 4 FREE STD EMER DEPT 7,539 $4,569.00
73001 CBC AUTOMATED 5,968 $384.00
75053 IVP SINGLE/INITIAL DRUG 5,170 $444.00
73017 UA W MICRO AUTO 4,177 $278.00
73025 COMP METABOLIC PANEL 3,969 $990.00
70810 CHEST XRAY 1 V 3,143 $1,453.00
75052 IVP EA ADD SEQ NEW DRUG 3,133 $251.00
6805 ONDANSETRON 4 MG VL 2,957 $360.32
62905 EKG TRACING ONLY 2,909 $1,325.00
75049 INJECTION IM OR SQ 2,791 $205.00
75009 LVL 2 FREE STD EMER DEPT 2,676 $1,523.00
68031 NS 1000 ML 2,675 $325.42
73024 BMP TOTAL CALCIUM 2,542 $855.00
73019 PREG URINE QUAL BY DOO 2,409 $255.00
73047 LIPASE 2,221 $370.00
75056 IV HYDRAT EA ADD HR 1,681 $190.00
5857 KETOROLAC 15 MG INJ 1,595 $361.22
73052 TROPONIN QUANT 1,555 $867.00
75008 LVL 1 FREE STD EMER DEPT 1,535 $851.00
75015 ED PROC CAT 2 1,440 $824.00
68037 NS 50 ML 1,417 $325.42
66614 HYDROMORPH 0.5 MG INJ 1,394 $363.32
31485 ZOFRAN (ODT) 4MG TAB 1,391 $48.37
45253 DEXAMETHASONE 4 MG PO 1,167 $52.63

View insurance options En Español