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Charges and Fees For Common Healthcare Services

Senate Bill (SB) 17-065: Transparency in Direct Pay Health Care Prices requires healthcare facilities, physicians, and providers to post prices for their most common healthcare services. Patients with health insurance are strongly encouraged to consult with their health insurer to determine accurate information about their financial responsibility for a particular health care service at this heath care facility. If you are not covered by health insurance, you are strongly encouraged to contact Colorado Mountain Medical, PC at 970 926 6350 to discuss payment options prior to receiving a health care service from this health care facility since posted health care prices may not reflect the actual amount of your financial responsibility.

Below is a list estimating the cost of Colorado Mountain Medical’s most commonly billed services.

CPT      Price    Description     
99202    $178    Outpatient Office Visit; New Patient; Straightforward    
99203    $265    Outpatient Office Visit; New Patient; Low Complexity     
99204    $368    Outpatient Office Visit; New Patient; Moderate Complexity    
99212    $105    Outpatient Office Visit; Established Patient; Straightforward  
99213    $170    Outpatient Office Visit; Established Patient; Low Complexity    
99214    $247    Outpatient Office Visit; Established Patient; Moderate Complexity   
99392    $252    Preventive Visit; Age 1-4; Established Patient  
99393    $251    Preventive Visit; Age 5-11; Established Patient 
99394    $275    Preventive Visit, Age 12-17, Established Patient    
99395    $281    Preventive Visit, Age 18-39, Established Patient  
99396    $300    Preventive Visit, Age 40-64, Established Patient  
99397    $323    Preventive Visit, Age 65 & over, Established Patient    
PNCK    NS       Prenatal Check (fee included in comprehensive pregnancy care)  
80050    $82      General Health Panel (GHP) (lab work) 
80053    $42      Comprehensive Metabolic Panel (CMP) (lab work) 
80061    $46      Lipid Panel (lab work)   
81003    $7        Urinalysis (dipstick)     
84153    $73      Prostate-Specific Antigen (PSA), total (lab work)  
84443    $68      Thyroid Stimulating Hormone (TSH) (lab work)    
85025    $28      Complete Blood Count (CBC, auto with auto diff.) (lab work)     
87651    $57      Strep A (Swab)  
90686    $59      Flu Shot, Adult and Injection
39448    $100    PCR Molecular (COVID-19 Diagnostic)

No Surprise Act & Good Faith

While the Good Faith Estimate & No Surprise Act does not apply to Colorado Mountain Medical, below is more information that is important for our patients understand their billing statements.

WHAT IS A “GOOD FAITH ESTIMATE?”
Patients have the right to receive a “Good Faith Estimate” explaining how much health care will cost. Under the law,
health care providers need to give patients who don’t have certain types of health care coverage or who are not
using certain types of health care coverage an estimate of their bill for health care items and services before those
items or services are provided.

This notice applies only to Vail Health Hospital, Shaw Cancer Center in Edwards, and Sonnenalp Breast Center
in Edwards.

WHAT IS “BALANCE BILLING” (SOMETIMES CALLED “SURPRISE BILLING”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment,
coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit
a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan.
Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and
the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs
for the same service and might not count toward your annual out-of-pocket limit. “Surprise billing” is an unexpected
balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency
or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider.

PATIENT RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory
surgical center, you are protected from surprise billing or balance billing.