NOTICE REGARDING HEALTH CARE PLAN COVERAGE
This freestanding emergency department (Northeast 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 $1,111.14 to $12,293.83. 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) 475-2403 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.
Northeast Emergency Department
Updated January 11, 2022
| Charge Description | Average Charge per Account |
|---|---|
| Single or first dose of medication IV | $522 |
| Complete panel of 14 blood tests | $1,575 |
| Urine test without microscope | $350 |
| Normal saline 1000ml | $458 |
| Chest XRAY 1 view | $845 |
| External recording of electrical activity of heart | $1,729 |
| 30mg injection of Ketorolac, a non-steroid anti-inflammatory medication | $113 |
| Second or each additional dose of medication delivered via IV | $732 |
| Blood test for heart muscle | $1,014 |
| Blood test for pregnancy | $714 |
| Basic metabolic panel with ionized calcium | $955 |
| 4mg vial of Ondansetron, used to prevent nausea and vomiting | $475 |
| Normal saline 50ml | $83 |
| Low osmolar contrast material used in diagnostic radiology | $1,185 |
| Each additional hour of IV fluid hydration | $312 |
| Complete blood count test | $208 |
| Computerized tomography "Cat Scan" of the abdomen and pelvis with contrast | $17,696 |
| Lactated ringers 1000ml | $591 |
| ED PROC CAT 2 | $2,870 |
| Acetamin 500 mg tablet | $7 |
| Ibuprofen 600 mg tablet | $28 |
| Throat swab to check for Group A strep, the cause of strep throat | $485 |
| Intramuscular or subcutaneous injection | $578 |
| Bacitracin antiseptic ointment | $19 |
| A sample of blood or other body fluid is taken to test for strep, staph, etc. | $406 |