NOTICE REGARDING HEALTH CARE PLAN COVERAGE

This freestanding emergency department (Stapleton 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 $591 to $11,900. 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) 475-7872 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.

Stapleton Emergency Department

Charge DescriptionAverage Charge per Account
Complete blood count lab test $435
1000ml bag of saline IV fluids $367
Single or first dose of medication delivered via IV $467
IV tubing $24
Catheter (needle) used to start an IV $12
30mg injection of Ketorolac, a non-steroidal anti-inflammatory medication $193
Urine test conducted via machine without microscope $220
Complete panel of 14 blood tests $1,047
External recording of the electrical activity of the heart $720
Second or each additional dose of medication delivered via IV $687
Basic panel of 7 or 8 blood tests, with ionized calcium $846
Basic panel of 7 or 8 blood tests, including total calcium $763
Each additional hour of IV fluid hydration $562
ED PROC CAT 2 $1,652
4mg vial of Ondansetron, used to prevent nausea and vomiting $351
Intramuscular or subcutaneous injection $365
Blood test for pancreatic enzymes $76
Ibuprofen 600MG tablet $1
Chest x-ray with 2 views $480
Rapid test for group a strep to diagnose strep throat $69
Blood test for pregnancy $198
Urine pregnancy test $142
Blood test for the heart muscle $881
Culture for group A strep $117
4mg oral dose of Ondansetron, used to prevent nausea and vomiting $2

Visit Site En EspaƱol

Contracted Plans

PlanCommercial Group and IndividualManaged MedicareManaged Medicaid
AETNA (Inc. Coventry and FirstHealth) All Networks All Networks N/A
Anthem BCBS All Networks (excluding Mountain Enhanced) All Networks (Excluding PPO) N/A
BrightHealth All Networks (Emergency Only) Not participating N/A
CIGNA All Networks N/A N/A
Clear Spring N/A All Networks N/A
Colorado Access N/A N/A All Networks
Humana Not participating All Networks N/A
InnoVage N/A All Networks N/A
Kaiser All Networks (Swedish ER and Belmar Locations only) All Networks and locations N/A
Multiplan/PHCS All Hospital Networks (excluding physician only networks) N/A N/A
Rocky Mountain Health Plan All Networks N/A All Networks
UnitedHealthcare All Networks (except Colorado Doctors Plan) All Networks N/A