policy title: centura health financial assistance policy · colorado springs pediatric dentistry...

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All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 1 of 17 POLICY TITLE: Centura Health Financial Assistance Policy DEPARTMENT: Revenue Management ORIGINATION DATE: 11/01/2006 CATEGORY: Billing EFFECTIVE DATE: July 1, 2016 ADDENDUM C NON-COVERED PROVIDERS (Revised 4/2/2018) *Provider list to be updated quarterly. The following professional charges are not covered by the Centura FAP. Inquiries should be made by the patient with these organizations directly as they may have their own financial assistance policies. Group Name 1ST CHOICE SURGICAL SERVICES 4319 CONSULTING LLC 5280 ANESTHESIA 5280 PEDIATRIC DENTISTRY AARON SMITH PLASTIC SURGERY ACADEMY PARK PEDIATRICS ADVANCED BRAIN AND SPINE, LLC ADVANCED GYNECOLOGY & INFERTILITY, PC ADVANCED ORTHOPEDIC AND SPORTS MEDICINE SPECIALISTS, PC ADVANCED PEDIATRICS ADVANCED SPINE & SPORTS SPECIALISTS, LLC ADVANCED UROLOGY, PC ADVANCED WOMEN'S HEALTH INSTITUTE ADVANTAGE ENT, LLP AFFA, LLC AFFILIATES IN ORAL & MAXILLOFACIAL SURGERY ALAN F STAGE MD, A PLLC ALAN REISMAN, DDS ALBRECHT WOMEN'S CARE DENVER IVF ALL ABOUT WOMENS CARE ALLERGY & ASTHMA CENTER ALLERGY & ASTHMA CENTER OF COLORADO, LLC ALLERGY & ASTHMA SPECIALISTS ALLERGY ASTHMA AND SINUS CENTER LLC ALPINE EYE CLINIC ALPINE SURGICAL LLC ALPINE UROLOGY PC ALTA VISTA DERMATOLOGY

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All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 1 of 17

POLICY TITLE: Centura Health Financial Assistance Policy DEPARTMENT: Revenue Management ORIGINATION DATE: 11/01/2006

CATEGORY: Billing EFFECTIVE DATE: July 1, 2016

ADDENDUM C

NON-COVERED PROVIDERS (Revised 4/2/2018)

*Provider list to be updated quarterly.

The following professional charges are not covered by the Centura FAP. Inquiries should be made by the patient with these organizations directly as they may have their own financial assistance policies.

Group Name

1ST CHOICE SURGICAL SERVICES

4319 CONSULTING LLC

5280 ANESTHESIA

5280 PEDIATRIC DENTISTRY

AARON SMITH PLASTIC SURGERY

ACADEMY PARK PEDIATRICS

ADVANCED BRAIN AND SPINE, LLC

ADVANCED GYNECOLOGY & INFERTILITY, PC

ADVANCED ORTHOPEDIC AND SPORTS MEDICINE SPECIALISTS, PC

ADVANCED PEDIATRICS

ADVANCED SPINE & SPORTS SPECIALISTS, LLC

ADVANCED UROLOGY, PC

ADVANCED WOMEN'S HEALTH INSTITUTE

ADVANTAGE ENT, LLP

AFFA, LLC

AFFILIATES IN ORAL & MAXILLOFACIAL SURGERY

ALAN F STAGE MD, A PLLC

ALAN REISMAN, DDS

ALBRECHT WOMEN'S CARE DENVER IVF

ALL ABOUT WOMENS CARE

ALLERGY & ASTHMA CENTER

ALLERGY & ASTHMA CENTER OF COLORADO, LLC

ALLERGY & ASTHMA SPECIALISTS

ALLERGY ASTHMA AND SINUS CENTER LLC

ALPINE EYE CLINIC

ALPINE SURGICAL LLC

ALPINE UROLOGY PC

ALTA VISTA DERMATOLOGY

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 2 of 17

AMERICAN SURGICAL PROFESSIONALS

AMERICAN VEIN AND VASCULAR INSTITUTE

ANANT KUMAR, MD LLC

ANESTHESIA CONSULTANTS

ANIMAS FOOT AND ANKLE PC

ANIMAS PLASTIC SURGERY, PC

AP FOOT AND ANKLE SPECIALISTS, PC

APEX EMERGENCY GROUP, PC

ARAPAHOE PARK PEDIATRICS

ARAPAHOE PROFESSIONAL SURGICAL ASSISTANTS

ARBOR FAMILY MEDICINE

ASARCH CENTER FOR DERMATOLOGY, LASER & MOHS SURGERY

ASHAKIRAN J SUNKU, MD LLC

ASSOCIATES IN EYE CARE, PC

ASSOCIATES IN GASTROENTEROLOGY, PC

ASSOCIATES IN MAXILLOFACIAL & ORAL SURGERY, PC

ASSOCIATES IN WOMEN'S CARE, PC

ASSOCIATES OF OTOLARYNGOLOGY

ASSURE NEUROMONITORING, LLC

AURORA PLASTIC SURGERY, PC

AURORA-DENVER CARDIOLOGY ASSOCIATES, PC

AUTOBEE DENTAL CENTER

AVISTA ADVENTIST HOSPITAL

AVISTA EMERGENCY PHYSICIANS

AVISTA WOMEN'S CARE

AXIS HEALTH SYSTEMS

BANNER HEALTH CLINIC - ANESTHESIA

BARIATRIC AND AESTHETIC SURGERY ASSOCIATES

BEHR PC

BELLA NATURAL WOMEN'S CARE

BETH ROLAND, M.D., PC

BISHOP/PETERSON, MD, PC

BLUE SKY NEUROLOGY A DIVISION OF CAREPOINT PC

BOULDER BONE AND JOINT

BOULDER EYE SURGEONS

BOULDER MEDICAL CENTER

BOULDER NEUROSURGICAL & SPINE ASSOC, PLLC

BOULDER NEUROSURGICAL & SPINE ASSOCIATES

BOULDER PLASTIC SURGERY PROF LLC

BOULDER VALLEY EAR, NOSE & THROAT ASSOCIATES

BOULDER VALLEY NEUROLOGY

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 3 of 17

BOULDER VALLEY PLASTIC SURGERY

BOULDER CENTRE FOR ORTHOPEDICS

BRAY SURGICAL ASSISTING

BRENT J SMITH, MD

BRIAN WILLOUGHBY, MD, PC

BRIARGATE PEDIATRIC DENTISTRY PC

BRIGHTON CARDIOLOGY

BROADWAY PLASTIC SURGERY

BROOMFIELD FAMILY PRACTICE

BROOMFIELD PEDIATRICS

BUCKLEY VISION INSTITUTE

BURNHAM ORAL SURGERY

BUTTON FAMILY PRACTICE

CAMPANILE PLASTIC SURGERY, LLC

CANON FAMILY MEDICINE

CARE PLUS SYSTEMS, INC.

CAREPOINT, PC

CAROL A. GOLDBERG, MD

CASTLE ROCK FOOT AND ANKLE CARE

CASTLE ROCK ORAL & MAXILLOFACIAL SURGERY

CASTLE ROCK PEDIATRICS

CASTLE ROCK SMILES PEDIATRIC DENTISTRY

CENTENNIAL PEDIATRICS PC

CENTENNIAL VALLEY PEDIATRICS

CENTER FOR COSMETIC SURGERY

CENTER FOR CRANIOFACIAL & FACIAL PLASTIC SURGERY

CENTER FOR HEADACHES & TMJ & SLEEP DISORDERS

CENTER FOR PLASTIC & AESTHETIC SURGERY

CENTER FOR PLASTIC SURGERY

CENTER FOR PLASTIC SURGERY AT CASTLE ROCK INC

CENTER FOR SPINE & ORTHOPEDICS, PC

CENTER FOR WOMEN'S HEALTH

CENTER OF SURGICAL SPECIALISTS, PC

CENTURA HEALTH AT HOME

CHERRY CREEK EYE PHYSICIANS & SURGEONS, PC

CHEYENNE FOOT & ANKLE, INC.

CHIEF SURGICAL ASSISTING, INC

CHILDREN'S CLINIC

CHILDREN'S EYE CENTER, PC

CHILDREN'S EYE PHYSICIANS

CHILDREN'S HOSPITAL COLORADO

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 4 of 17

CHILDREN'S HOSPITAL COLORADO

CHIPS CHILDREN'S INPATIENT PHYSICIAN SERVICES

CHPG PC SS

CHRISTOPHER G VIALPANDO MD, PLLC

CHRISTOPHER YC LOUIE, MD, PC

CITI SURGERY ASSISTING (SOLO PRACTICE)

CK SURGICAL, LLC

CLARITY DERMATOLOGY, PLLC

CLEAR CREEK MEDICAL GROUP

CLINICA FAMILY HEALTH SERVICES

CLINTON CALLAHAN, DMD, PC

CNS MEDICAL GROUP, PC

COAL CREEK FAMILY MEDICINE

COAL CREEK PLASTIC & COSMETIC SURGERY

COLORADO AESTHETIC & PLASTIC SURGERY, PC

COLORADO ALLERGY & ASTHMA CENTERS PC

COLORADO BARIATRIC SURGERY INSTITUTE

COLORADO BLOOD AND CANCER CARE

COLORADO BRAIN & SPINE INSTITUTE, LLC

COLORADO CARDIOVASCULAR SURGICAL ASSOC PC

COLORADO CENTER FOR GYNECOLOGIC ONCOLOGY

COLORADO CENTER FOR NEUROSCIENCE

COLORADO CENTER FOR REPRODUCTIVE MEDICINE

COLORADO CENTER OF ORTHOPAEDIC EXCELLENCE

COLORADO CHILDRENS MEDICAL GROUP

COLORADO CLINICS FOR THE FOOT AND ANKLE

COLORADO COLON & RECTAL SPECIALISTS

COLORADO COMPREHENSIVE SPINE INSTITUTE, LLC

COLORADO DERMATOLOGY CENTER

COLORADO DERMATOLOGY INSTITUTE

COLORADO EAR, NOSE, & THROAT

COLORADO ENT AND ALLERGY

COLORADO EYE INSTITUTE

COLORADO FACIAL PLASTIC SURGERY CENTER

COLORADO FAMILY ORTHOPEDICS

COLORADO FOOT AND ANKLE

COLORADO FOOT AND ANKLE CLINIC, PC

COLORADO FOOT AND ANKLE SPORTS MEDICINE, LLC

COLORADO HAND CENTER

COLORADO HEALTH MEDICAL GROUP GENERAL & VASCULAR SURGERY

COLORADO HEALTH PROVIDER, LLC

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 5 of 17

COLORADO HEARING & BALANCE CLINIC

COLORADO HEART AND VASCULAR PC

COLORADO HEART CLINIC

COLORADO HOSPITALIST COMPANY

COLORADO IMAGING ASSOCIATES, PC

COLORADO INFECTIOUS DISEASE ASSOCIATES

COLORADO INSTITUTE OF COLON & RECTAL SURGERY

COLORADO KIDNEY CARE PC

COLORADO NEURODIAGNOSTICS

COLORADO OPHTHALMOLOGY ASSOCIATES

COLORADO ORAL SURGERY

COLORADO ORTHOPAEDICS

COLORADO PAIN CARE

COLORADO PAIN CONSULTANTS

COLORADO PHYSICIAN SURGICAL AST

COLORADO PLASTIC SURGERY CENTER

COLORADO PODIATRY CONSULTANTS PC

COLORADO PULMONARY ASSOCIATES

COLORADO PULMONARY INTENSIVISTS

COLORADO REHABILITATION AND OCCUPATIONAL MEDICINE

COLORADO REHABILITATION PHYSICIANS

COLORADO RETINA ASSOCIATES, PC

COLORADO SPRINGS DERMATOLOGY CLINIC, PC

COLORADO SPRINGS EAR ASSOCIATES

COLORADO SPRINGS EYE CLINIC

COLORADO SPRINGS FOOT & ANKLE CLINIC

COLORADO SPRINGS INTERVENTIONAL PAIN MANAGMENT PC

COLORADO SPRINGS NEPHROLOGY

COLORADO SPRINGS NEUROLOGICAL ASSOCIATES

COLORADO SPRINGS ORAL SURGERY

COLORADO SPRINGS ORTHOPAEDIC GROUP

COLORADO SPRINGS ORTHOPAEDIC GROUP - AUDUBON

COLORADO SPRINGS PEDIATRIC DENTISTRY

COLORADO SPRINGS PULMONARY CONSULTANTS, PC

COLORADO SPRINGS RADIOLOGISTS, PC

COLORADO SPRINGS SURGICAL ASSOCIATES, PC

COLORADO SPRINGS UROLOGICAL ASSOCIATES, PLLC

COLORADO SURGICAL SERVICE PC

COLORADO VOICE CLINIC, PC

COMMUNITY ANESTHESIA CONSULTANTS LLC

COMMUNITY FOOT & ANKLE CLINIC

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 6 of 17

COMPREHENSIVE ENT, PC

CONCEPTIONS REPRODUCTIVE ASSOCIATES OF COLORADO

CONRAD J TIRRE, MD

CONSULTANTS IN NEPHROLOGY AND HYPERTENSION

CORNEAL CONSULTANTS OF COLORADO, PC

CORNERSTONE ORTHOPEDICS & SPORTS MEDICINE

CORNERSTONE PEDIATRIC ASSOCIATES, INC

CORWIN CLINIC SURGICAL, PC

CRAIG HORNBARGER, MD F.A.C.S

CRITICAL CARE AND PULMONARY CONSULTANTS, PC

CRITICAL CARE, PULMONARY & SLEEP ASSOC PLLP

CRNA ASSOCIATES, INC

CROWLEY COUNTY CORRECTIONAL FACILITY

CUTARELLI VISION

CUTTING EDGE SURGICAL, INC.

DANIEL J MACFARLANE DPM PC

DAVITA MEDICAL GROUP-BRIARGATE OFFICE

DEBORA MA, MD PC

DENTAL ARTS OF CHERRY HILLS

DENVER BACK PAIN SPECIALISTS, LLC

DENVER FOOT & ANKLE CLINIC

DENVER HEALTH MEDICAL CENTER

DENVER HEART

DENVER NEUROLOGICAL CLINIC

DENVER ONCOLOGY PROFESSIONAL CORP

DENVER ORAL & MAXILLOFACIAL SURGERY

DENVER SPINE CENTER

DEPENDABLE SURGICAL ASSISTANTS, INC.

DERMA TAUT INTERNATIONAL, PC

DERMATOLOGY & ENDOCRINOLOGY, LLC

DERMATOLOGY ASSOCIATES OF COLORADO

DERMATOLOGY CLINIC

DEXTER D KOONS, MD, PC

DIEHL ANESTHESIA

DIGESTIVE DISEASE SPECIALISTS OF COLORADO

DIGESTIVE HEALTH ASSOCIATES, PC

DIVERSIFIED RADIOLOGY OF COLORADO

DM CAMPBELL, DO, PC

DOCTOR'S FIRST SURGICAL ASSISTING

DOCTORS MEDICAL GROUP OF COLORADO SPRINGS

DR. DOUGLAS P PELLER, DO, LLC

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 7 of 17

DRS. DAY & RUBY

DRS. RENDLER & ARGUELLO

DRY CREEK SURGERY PC

DTC EYE ASSOCIATES, PC

DURANGO DERMATOLOGY

DURANGO ENT

DURANGO NEUROLOGICAL ASSOCIATES, PC

EAGLE-SUMMIT FOOT & ANKLE, PC

EAR, NOSE AND THROAT OF PARKER

EBERT FAMILY CLINIC

EDWARD K RACZKA, DPM, PC

ELDORADO RETINA ASSOCIATES PC

ELITE ANESTHESIA CONCEPTS

ELITE NEUROMONITORING, LLC

ELITE OCULOPLASTIC SURGERY, PC

ELIZABETH EHRHARDT, MD., LLC

ELMER A VILLALON, DMD

ENDOCRINE SERVICES, PC

ERICKSON PEDIATRIC DENTISTRY & ORTHODONTICS

ERIK H RIEGER, MD, PC

ESPRIT WOMAN CARE

EVANS ARMY COMMUNITY HOSPITAL (FORT CARSON)

EXCELLENCE IN ORAL & MAXILLOFACIAL SURGERY

EXCEPTIONAL CARE FOR WOMEN, PLLC

EXEMPLA GOOD SAMARITAN HOSPITAL

EYE ASSOCIATES OF COLORADO SPRINGS, PC

EYE CARE CENTER OF NORTHERN COLORADO

EYE SPECIALISTS OF COLORADO

FAMILY HEALTH CARE CENTER

FANTE EYE AND FACE CENTER

FIRST ASSISTANT SERVICES OF SOUTHWEST MISSOURI

FLATIRON INTERNAL MEDICINE

FLATIRONS OPHTHALMOLOGY

FLATIRONS SURGICAL ASSISTING, INC.

FLORENCE MEDICAL CENTER

FOCUS ON KIDS

FOOT AND ANKLE INSTITUTE OF COLORADO

FOOT SPECIALIST ASSOCIATES, PC

FOOTHILLS ANESTHESIA, LLC

FOOTHILLS UROGYNECOLOGY, PC

FOOTHILLS UROLOGY

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 8 of 17

FORTE SURGICAL ASSISTING

FOUR CORNERS FOOT AND ANKLE PC

FOUR CORNERS OB/GYN

FOUR CORNERS ORAL & MAXILLOFACIAL SURGERY

FOUR CORNERS SMILES 4 KIDS, INC.

FRANK BOSKOVICH NP-C, RNFA

FREELANCE ASSISTANTS

FREMONT FOOT AND ANKLE

FRONT RANGE CENTER FOR SPINE & SPORTS MEDICINE

FRONT RANGE EMERGENCY SPECIALISTS PC

FRONT RANGE EYE PHYSICIANS

FRONT RANGE FOOT & ANKLE CLINIC

FRONT RANGE OBSTETRICS & GYNECOLOGY, PC

FRONT RANGE ORTHOPEDICS & SPINE

FRONT RANGE OTOLARYNGOLOGY & FACIAL PLASTIC SURG PC

FRONT RANGE SPINE AND NEUROSURGERY

FRONT RANGE SURGICAL ASSOCIATES, PC

FRONT RANGE SURGICAL SERVICES, PC

FRONTIER NEUROLOGY AND NEUROMUSCULAR CLINIC

GARY R. SNIDER, MD

GENITOURINARY SURGICAL CONSULTANTS

GORMAN MEDICAL LLC

GREENWOOD EAR, NOSE & THROAT SPECIALISTS, PC

GREENWOOD PEDIATRICS, PC

GREGORY J LIEBSCHER, MD

GROSSMAN PLASTIC SURGERY

GUARDIAN ANESTHESIA SERVICES INC

H. RANDOLPH FRANK, MD, PC

HAAS VISION CENTER

HANSON CLINIC PC

HARVARD AVENUE INTERNAL MEDICINE

HEIDI J OSTER MD, PC

HEOLOGICS

HERITAGE INTERNAL MEDICINE, PC

HGD SURGICAL ASSISTING SERVICES, INC

HIGH COUNTRY SURGICAL ASSISTING, INC.

HIGH PLAINS ANESTHESIA CONSULTANTS, PC

HIGH PLAINS COMMUNITY HEALTH CENTER

HINES-SIGHT

HOPE INTERNAL MEDICINE OF PUEBLO, LLC

HORIZONS FOOT & ANKLE CLINIC

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 9 of 17

IMMUNOE HEALTH CENTERS

IMPLANT AND ORAL SURGERY CENTER

INCLINE ORTHOPAEDICS

INFECTIOUS DISEASE SPECIALISTS, PC

INPATIENT CONSULTANTS OF COLORADO

INSIGHT RETINA CONSULTANTS, PC

INTEGRATED EAR, NOSE AND THROAT, PC

INTERMOUNTAIN FOOT AND ANKLE

INTERNAL MEDICINE ASSOCIATES OF COLORADO SPRINGS

INTERNAL MEDICINE OF COLORADO, PC

INTERNAL MEDICINE SOUTHWEST, PC

INTERWEST REHABILITATION, LLC

INTRANERVE, LLC

INTRAOPS NEUROMONTORING, LLC

IRON HORSE PEDIATRICS

JACK D AIKIN, MD

JAMES PETTET DPM PC

JAMES R DENTON, MD

JAN E LEO, MD, PC

JB.LLC

JDI SURGICAL

JEFFREY L HOLTGREWE, MD, PC

JEFFREY WILLIAMS, DO PC

JIM HARPSTER SURGICAL ASSISTING, INC

JOHN A LAMPE, MD, PC

JOHN A. ROTHCHILD, DDS, PC

JOSEPH P. ZUFALL, D.D.S.

KEITH A NAFTULIN, DPM, PC

KENDRA L. PATTERSON, DMD, PC

KEVIN J HEINZE, MD, PC

KILSAN KOH, M.D., F.A.C.S.

KRISTINE A. EULE, MD

LA PLATA FAMILY MEDICINE ASSOCIATES PC

LADNER FACIAL PLASTIC & COSMETIC SURGERY

LAFAYETTE PEDIATRICS AND INTERNAL MEDICINE

LAKEWOOD MEDICAL CENTER

LAWRENCE C. WANG, MD, P.C.

LITTLETON FOOT AND ANKLE CLINIC, LLC

LITTLETON PEDIATRIC MEDICAL CENTER

LIVENEW, CO

LONE TREE INTERNAL MEDICINE & PEDIATRICS

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 10 of 17

LONE TREE PEDIATRICS

LONE TREE SURGICAL ASSOCIATES, PC

LONE TREE SURGICAL FIRST ASSISTING, LLC

LONG TERM CARE & REHAB CONSULTANTS LLC

LONGMONT HOSPITALIST GROUP

LONGMONT PULMONARY AND CRITICAL CARE ASSOCIATES

LONGS PEAK EMERGENCY PHYSICIANS PC

LOUISVILLE FOOT & ANKLE CLINIC

M.A.D.E. LLC

MALAMUD SURGICAL SERVICES, INC.

MAPLE LEAF ORTHOPEDICS

MARC M TREIHAFT MD

MARGOLIS VISION

MARY JANE HOSCH CRNFA

MCDONALD SURGICAL ASSISTING, L.L.C.

MCVAY FOOT AND ANKLE, PC

MEDSURANT MONITORING

MELISSA YANOVER, MD- KIDNEY ASSOC OF CO PC

MEMORIAL GENERAL AND VASCULAR SURGERY

METAMORPHOSIS, LTD

METRO DENVER PAIN MANAGEMENT

METROPOLITAN FOOT AND ANKLE

METROPOLITAN PATHOLOGISTS

MICHAEL A VOLZ, MD PC

MICHAEL BATEMAN MD, PC

MICHAEL C BATEMAN, MD

MICHAEL DOUGLAS MIGNOLI MD PC

MICHAEL J. HAWES, MD, PC

MILE HIGH EYE INSTITUTE

MILE HIGH PLASTIC SURGERY

MILE HIGH SURGICAL ASSISTANT, INC

MILE-HI NEUROLOGY SERVICES, PC

MIND SPRINGS HEALTH

MOHAMMED ZUBAIR, MD

MOUCHANTAT PLASTIC SURGERY PC

MOUNTAIN BLUE CANCER CARE CENTER

MOUNTAIN PEAKS UROLOGY, PC

MOUNTAIN STATES PATHOLOGY

MOUNTAIN VIEW MEDICAL GROUP

MOUNTAIN VIEW SURGICAL ASSOCIATES

MOUNTAINTOP DERMATOLOGY

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 11 of 17

MUNNI RAMAIAH SELAGAMSETTY, MD

MY KIDS DENTIST

NANCY TAOKA MD, LLC

NATIONAL JEWISH CENTER

NATIONAL NEUROMONITORING SERVICES, LLC

NERVEWATCH, LLC

NEUROHEALTH, LLC

NEUROLOGY OF THE ROCKIES PC

NEUROMONITORING ASSOCIATES, LLC

NEUROMONITORING ASSOCIATES, LLC

NEUROPHYSIOLOGIC, INC

NEUROSURGICAL AND SPINE SPECIALISTS PC

NEW WEST PHYSICIANS

NORMAN P PAYEA II, MD

NORTH METRO INFECTIOUS DISEASE SPECIALIST, PC

NORTH SPRINGS SURGICAL ASSOCIATES, PC

NORTHERN COLORADO ANESTHESIA PROFESSIONALS, PLLC

NORTHWEST NEUROLOGY, PC

NORTHWEST OMS

OBSTETRIX MEDICAL GROUP OF COLORADO, P C

OCULOPLASTICS AND OPHTHALMOLOGY AT LITTLETON

OLIVIA VYNN ADAIR, MD PC

OMNI EYE SPECIALISTS

OPTIMA WOMEN'S HEALTH CARE

ORAL AND MAXILLOFACIAL SURGERY SPECIALISTS OF COLO SPGS

ORAL SURGERY ASSOCIATES

ORAL SURGERY CENTER

ORAL SURGERY OF THE ROCKIES

ORAL SURGERY SPECIALISTS OF PUEBLO, PLLC

ORTHOCOLORADO HOSPITAL

ORTHOPAEDIC PHYSICIANS OF COLORADO

OUR LADY OF HOPE MEDICAL CLINIC

PAIN MANAGEMENT OF THE ROCKIES, PC

PANKAJ NASHIKKAR MD, LLC

PANORAMA ORTHOPEDICS, PC

PARADIGM SURGICAL SERVICES, INC

PARAMOUNT IOM, LLC

PARK MEADOWS COSMETIC SURGERY

PARKER PEDIATRICS & ADOLESCENTS, PC

PARKVIEW FAMILY MEDICINE

PEAK ANESTHESIA & PAIN MANAGEMENT

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 12 of 17

PEAK ENT AND VOICE CENTER

PEAK GASTROENTEROLOGY ASSOCIATES

PEAK NEUROLOGY, PC

PEAK ORTHOPEDICS

PEAK PEDIATRICS, LLC

PEAK PERFUSION GROUP, INC

PEAK PERFUSION GROUP, INC

PEAK VISTA COMMUNITY HEALTH CENTERS

PEDIATRIC ASSOCIATES OF DURANGO, PC

PEDIATRIC DENTAL SPECIALTIES

PEDIATRIC PARTNERS OF THE SOUTHWEST

PEDIATRIC PATHWAYS

PEDIATRICS 5280

PEDIATRICS AT THE MEADOWS

PENROSE ST FRANCIS MEDICAL CENTER

PERFORMANCE CARDIOLOGY

PETER R YARNELL MD PC

PHILIP C MARIN, MD

PHYSICIAN ASSISTANT SURGICAL SERVICES

PIKES PEAK ANESTHESIA

PIKES PEAK HOSPICE & PALLIATIVE CARE

PIKES PEAK NEPHROLOGY ASSOCIATES

PIKE'S PEAK ORAL SURGERY

PINE CREEK VISION CLINIC

PINNACLE FOOT & ANKLE CLINIC PC

PINNACLE FOOT AND ANKLE CLINIC

PINNACLE PEDIATRICS AND INTERNAL MEDICINE

PINNACLE SURGICAL SERVICES

PIUS K KAMAU, MD

PLATT RIVER ASSISTING LLC

PODIATRY ASSOCIATES, PC

PODIATRY ASSOCIATES, PC

POLITZER & KASPER O.D.'S PC

PRECISION ORTHOPEDICS, PC

PRECISION PLASTIC AND HAND SURGERY, LLC

PREMIER ANESTHESIA OF COLORADO

PREMIER SURGERY

PRO ACTIVE PODIATRY

PROFESSIONAL ALLIANCE SURGICAL ASSISTING

PROFESSIONAL ASSOCIATES OF SURGICAL SERVICES

PSA, INC

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 13 of 17

PUEBLO ANKLE AND FOOT CARE, PLLC

PUEBLO ASSOCIATES IN OB/GYN

PUEBLO BONE & JOINT CLINIC

PUEBLO COMMUNITY HEALTH CENTER, INC

PUEBLO EAR, NOSE & THROAT CLINIC

PUEBLO NEUROLOGY

PUEBLO PULMONARY ASSOCIATES

PUEBLO RADIATION ONCOLOGY

PUEBLO RADIOLOGICAL GROUP

PULMONARY ASSOCIATES

QUANTUM NEUROMONITORING CORPORATION

RADIATION ONCOLOGY PC

RADIOLOGY ASSOCIATES OF DURANGO

RADIOLOGY IMAGING ASSOCIATES PC

RADIOLOGY IMAGING ASSOCIATES PC

RAVAL FACIAL AESTHETICS & ENT, PC

REAL TIME NEUROMONITORING ASSOCIATES OF CALIFORNIA, PC

REAL TIME NEUROMONITORING ASSOCIATES, PLLC

RED ROCKS FOOT & ANKLE CENTER

RED ROCKS OB/GYN

RESTORATION PLASTIC SURGERY PC

RETINA CONSULTANTS OF SOUTHERN COLORADO, PC

REVALLA PLASTIC SURGERY

ROBERT L BLAYNEY, MD

ROBERT MCINTYRE, PHD

ROBERT SNYDER, MD

ROBINSON COSMETIC SURGERY

ROCK CANYON FOOT & ANKLE CLINIC, LLC

ROCKY MOUNTAIN ADVANCED SPINE ACCESS

ROCKY MOUNTAIN BRAIN & SPINE INSTITUTE

ROCKY MOUNTAIN CANCER CENTERS LLP

ROCKY MOUNTAIN COSMETIC & RECONSTRUCTIVE SURGERY ASSOC., P.C

ROCKY MOUNTAIN EAR CENTER

ROCKY MOUNTAIN ENT

ROCKY MOUNTAIN EYE CENTER INC

ROCKY MOUNTAIN FAMILY PRACTICE OF LEADVILLE

ROCKY MOUNTAIN FERTILITY CENTER

ROCKY MOUNTAIN FOOT & ANKLE CENTER

ROCKY MOUNTAIN GASTROENTEROLOGY ASSOC PLLC

ROCKY MOUNTAIN HEALTH CENTERS PEDIATRICS PC

ROCKY MOUNTAIN INFECTIOUS DISEASE SPECIALISTS PC

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 14 of 17

ROCKY MOUNTAIN MEDICAL SVCS INC

ROCKY MOUNTAIN NEURODIAGNOSTICS

ROCKY MOUNTAIN NEUROSURGERY

ROCKY MOUNTAIN PAIN SOLUTIONS

ROCKY MOUNTAIN PEDIATRIC DENTISTRY, PC

ROCKY MOUNTAIN PEDIATRIC GASTROENTEROLOGY

ROCKY MOUNTAIN PEDIATRIC SURGERY

ROCKY MOUNTAIN PEDIATRIC UROLOGY

ROCKY MOUNTAIN PERFUSIONISTS

ROCKY MOUNTAIN PRIMARY CARE

ROCKY MOUNTAIN RADIOLOGISTS

ROCKY MOUNTAIN RETINA ASSOCIATES

ROCKY MOUNTAIN SPINE CLINIC PC

ROCKY MOUNTAIN SURGICAL ASSISTS LLC

ROCKY MOUNTAIN SURGICAL SUPPORT, INC.

RON W PELTON, MD, PC

ROSS M. LEIBOVITZ, M.D., P.C.

ROYAL GORGE EMERGENCY MEDICINE SPECIALISTS PC

RUSSELL J. WEISTER, MD, PC

SAGE FAMILY MEDICINE

SAN LUIS VALLEY FOOT AND ANKLE CLINIC

SANGRE DE CRISTO HOSPICE

SANTA FE ORAL SURGERY

SCHMIDT FACIAL PLASTIC SURGERY

SEMPER HEALTHCARE

SENTIENT MEDICAL SYSTEMS

SHARP PODIATRIC MEDICINE AND SURGERY

SIMPLY KIDS DENTAL

SKIN MD DERMATOLOGY & SKIN ENHANCEMENT CENTER

SMALL WORLD PEDIATRICS

SOUTH DENVER CARDIOLOGY ASSOCIATES

SOUTH DENVER ENT AND ALLERGY

SOUTH DENVER GASTROENTEROLOGY, PC

SOUTH DENVER NEUROSURGERY

SOUTH DENVER OB/GYN, PC

SOUTH DENVER OB/GYN, PC

SOUTH DENVER PHYSICIANS PLLC

SOUTH DENVER SPINE PC

SOUTH WEST NEUROMONITORING

SOUTHERN COLORADO CLINIC

SOUTHERN COLORADO DERMATOLOGY CLINIC, PC

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 15 of 17

SOUTHERN COLORADO EMERGENCY SPECIALISTS

SOUTHERN COLORADO NEPHROLOGY ASSOCIATES

SOUTHERN COLORADO PSYCHIATRIC, PC

SOUTHERN WAY SURGICAL INC

SOUTHPARK INTERNAL MEDICINE, PC

SOUTHWEST COLORADO EAR NOSE & THROAT ASSOCIATES

SOUTHWEST DIAGOSTICS LABS

SOUTHWEST EMERGENCY PHYSICIANS

SOUTHWEST MIDWIVES

SOUTHWEST RETINA CONSULTANTS, PC

SPECIALTY CARE

SPECIALTYCARE IOM SERVICES LLC

SPINAL DIAGNOSTICS & PAIN MANAGEMENT

SPINE COLORADO

SPINE, PAIN & REHABILITATION CENTER OF CO

SPORTS AND ORTHOPEDIC REHABILITATION PLLC

SPRINGS AESTHETICS

ST CATHERINE HOSPITAL

ST THOMAS MORE ORTHOPEDICS

STATCALL SURGICAL ASSISTING INC

STEADMAN HAWKINS CLINIC

STEADMAN HAWKINS CLINIC

STEPHEN VIALPANDO MD

STEVEN BARBEE, MD

STEVEN KINNETT, MD, PC

STM FAMILY MEDICINE

STM FAMILY MEDICINE

STRANSKY SURGICAL ASSISTING

STRATA ANESTHESIA

SUMMIT HOSPITALISTS

SUMMIT MEDICAL CLINIC

SUMMIT PEDIATRIC DENTAL SPECIALTIES

SURGERY SPECIALISTS OF FREMONT COUNTY

SURGICAL CONSULTANTS OF AURORA, PC

SURGICAL EXPERTISE, PC

SURGICAL STEELE ASSISTANTS, LLC

SURGONE PC

SWAN MOUNTAIN WOMEN'S CENTER, PC

TABLE MOUNTAIN FOOT & ANKLE

TAD R HEINZ, MD PC

TAYLOR FIRST ASSISTING SERVICES, LLC

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 16 of 17

THE COLORADO RETINA CENTER

THE COLORADO SURGICAL CLINIC

THE EYE CENTER

THE LITTLETON CLINIC

THE PAIN & REHAB INSTITUTE

THE PEAK PHYSICAL MEDICINE

THE UROLOGY CENTER OF COLORADO

THE WOMEN'S HEALTH GROUP

THE WRIGHT EYE CENTER

THOMAS E. BOWSER MD PLLC

THOMAS NARSETE, MD, PC

TIMOTHY F. STACEY, DDS

TOMASETTI AND MCLAIN ORAL MAXILLOFACIAL SURGERY

TOXICOLOGY ASSOCIATES

TRANSITIONS CHRONIC CARE

TRENT HOVENGA, MD, PC

UCHEALTH LONGMONT CLINIC

UNIPATH

UNIPATH

UNIVERSITY OF COLORADO HOSPITAL

UROLOGY ASSOCIATES, PC

UROLOGY CLINIC PC

UROLOGY CONSULTANTS, PC

UROLOGY OF PUEBLO, PC

US ACUTE CARE SOLUTIONS OF COLORADO, LLC

US AIR FORCE ACADEMY

US ANESTHESIA PARTNERS OF COLORADO, LLC

USACS COMMUNITY EMERGENCY SERVICES OF COLORADO, INC

VAIL-SUMMIT ORTHOPAEDICS PC

VANGUARD SKIN SPECIALISTS

VARRA SURGICAL ASSISTING

VASCULAR INSTITUTE OF THE ROCKIES

VCA-IN SURGERY ASSISTING SERVICES, LLC

VELOCITY NEUROCARE LLC

VIRTUAL RADIOLOGIC PROFESSIONALS, LLC

VISION CARE SPECIALISTS, PC

VISION INSTITUTE

VISIONAIRE EYE CONSULTANTS

W J GAREHIME, PC

WESTERN INFECTIOUS DISEASE CONSULTANTS PC

WESTERN NEPHROLOGY AND METABOLIC BONE DISEASE, PC

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained.

Category – Statewide Financial Assistance Policy Page 17 of 17

WESTERN ORTHOPAEDIC PC

WESTSIDE WOMEN'S CARE

WHEAT RIDGE GENERAL & VASCULAR SURGICAL ASSOC, PC

WILEY J JINKINS, MD, PC

WILLIAM G RAINER, JR, M.D., PA

YOUNG AT HEART DENTISTRY

ZWIEBEL CENTER FOR PLASTIC SURGERY