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 $1,010.13 to $11,176.21. 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, 2021

Charge Description Average Charge per Account
4 mg oral dose of Ondansetron $7
Computerized tomography "Cat Scan" of the abdomen and pelvis with contrast $15,451
Lactated ringers solution 1000 ml $558
Single or first dose of medication IV $431
1000 ML bag of saline IV fluid $403
Complete panel of 14 blood tests $1,381
Each additional hour of IV fluid hydration $258
Urine test conducted via machine with microscope $395
Inhalation treatment for airway obstruction $199
30mg injection of Ketorolac, a non-steroid anti-inflammatory medication $98
External recording of electrical activity of heart $1,583
Blood test for pancreatic enzymes $536
4mg vial of Ondansetron, used to prevent nausea and vomiting $417
IBUPROFEN 600MG TAB $24
Second or each additonal dose delivered IV $638
Urine test without microscope $307
ED PROC CAT 2 $2,385
Blood test for heart muscle $911
Rapid stress test to diagnose strep throat $427
Low osmolar contrast material used in diagnostic radiology $947
Culture for group A strep $354
Chest x-ray with two views $1,288
Normal Saline 50 ml $72
Chest x-ray with one view $752
Acetaminophen 500mg tablet $6

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North Suburban ER Level Charges

When a patient presents in our Emergency Room, our first priority is providing the necessary medical screening examination and stabilizing care without delay for the patient's emergency medical condition regardless of a patient's ability to pay. Emergency care is not conditioned on financial considerations. Once you have received a medical screening examination and stabilizing care has begun, you may want to discuss your care plan and the estimated cost of that Emergency Room care.

Emergency Room charges are based on the level of emergency care provided to our patients at North Suburban Medical Center, Northwest ER and Northeast ER. Our Emergency Room relies on a scale called the emergency management billing scale to rate a patient's level of acuity. The levels, with level 1 representing basic emergency care to level 5 representing an immediate life-threatening condition, reflect the type of accommodations needed, the staff and resources required, the intensity of care and the amount of time needed to provide emergency and stabilizing care.

The following charges do not include fees for medication, supplies, additional procedures that may be required for emergency or stabilizing care or imaging services such as CT scan, an X­ ray, or a MRI. The charges listed below also do not include fees for Emergency Room physicians, who will bill separately for their services.

  • Level 1: $1,010.13
  • Level 2: $2,455.95
  • Level 3: $5,578.31
  • Level 4: $9,347.43
  • Level 5: $11,176.21