Aviso en español.

Right to Receive a Good Faith Estimate of Expected Charges

You have the right to receive a “Good Faith Estimate” explaining how much your 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.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
    • If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling.
    • If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling.
    • You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
  • If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.

 

New Patient Office Visit    
99202 Focused $79.00
99203 Expanded $ 120.00
99204 Detailed $ 181.00
99205 Comprehensive $ 238.00
Established Patient Office Visit  
99211 Miminimal $39.00
99212 Focused $93.00
99213 Expanded $ 148.00
99214 Detailed $ 209.00
99215 Comprehensive $ 293.00
New Patient Physical  
99381 Infant under 1 $ 182.00
99382 Early Childhood 1-4 $ 191.00
99383 Late Childhood 5-11 $ 199.00
99384 Adolescent 12-17 $ 215.00
99385 Adult 18-39 $ 230.00
99386 Adult 40-64 $ 275.00
99387 Adult 65+ $ 290.00
Established Patient Physical  
99391 Infant under 1 $ 164.00
99392 Early Childhood 1-4 $ 175.00
99393 Late Childhood 5-11 $ 175.00
99394 Adolescent 12-17 $ 192.00
99395 Adult 18-39 $ 196.00
99396 Adult 40-64 $ 220.00
99397 Adult 65+ $ 224.00

 

The health care price for any given health care service is an estimate. The actual charges for health care services are dependent on the circumstances at the time the service is rendered.

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 service provided by a health care provider at this office. If you are not covered by health insurance, you are strongly encouraged to contact our billing office at 720-728-5170 to discuss payment options prior to receiving a health care service from a health care provider at this office since posted health care prices may not reflect the actual amount of your financial responsibility.