Mobile dental anesthesia providers servicing Boulder, Denver, Fort Collins, Colorado Springs and everything in between.
Click the box above to complete the medical history prior to anesthesia
All non-medicaid patients must sign the financial agreement
Haga clic en el cuadro de arriba para completar el historial médico antes de la anestesia
ANESTHESIA DEPOSIT AND FEES
See Sample Bill at the bottom of the page
All patients must sign the financial agreement that can be completed using the following link:
To submit payment for the deposit please use the links below. The entire fee for the anesthesia services rendered is determined by the length of the surgery being performed. The anesthesia billing time is 30 minutes longer than dental treatment time. This allows for the anesthesia team to provide anesthesia services 15 minutes on either end of the procedure.
The final bill will be available as soon as the surgery is compete. Dr. Yancey currently accepts medicaid and fee-for-service only. This bill is provided to help patients submit this to their private insurance if they choose to do so.
Once the deposit is received your appointment will be confirmed. Full payment is required on the day of anesthesia. After submitting the deposit please sign electronically the financial agreement below.
Please don't hesitate to email our staff at info@mountainda.com with any payment questions. Thank You.
PEDIATRIC PATIENTS (13 years old and younger)
ADULT PATIENTS (14 years old and older)
PEDIATRIC FEES
1. $950 fee for every case which is 2 hours or less
2. $600/hr billed in 15 minute increments for cases 2 hours or longer
PEDIATRIC DEPOSIT
There is a mandatory $300 deposit in order to hold the appointment.
ADULT FEES
1. $750 for every case which is 1 hour or less
2. $600/hr billed in 15 minute increments for cases 1 hour or longer
ADULT DEPOSIT
There is a mandatory $500 deposit in order to hold the appointment.
Please sign the financial agreement below. Thank you
Please sign the financial agreement below. Thank you
Custom Payment
You can submit the remainder of your payment using the following button:
Mountain dental anesthesia fees are separate from the dental/surgery fees. Mountain dental anesthesia accepts all major credit cards and cash. Ask about a cash discount.
Both of these forms can be signed electronically above