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 additional 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 |