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 $911.53 to $14,157.24. 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 here.

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 below. 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.

Swedish Belmar Emergency Department

Updated May 31, 2022

Charge Code Charge Description Count of Accts Current Price
998390 LVL 3 FREE STD EMER DEPT 5,940 $5,033.80
998403 LVL 4 FREE STD EMER DEPT 4,419 $8,435.03
998889 CBC AUTOMATED 3,568 $235.86
998958 COMP METABOLIC PANEL 2,476 $797.30
998538 IVP SINGLE/INITIAL DRUG 2,454 $641.42
919488 CATH IV 20GX1.16 INSYTE 2,329 $15.00
884375 SOD CHL 0.9% 1000ML BAG 2,217 $783.30
112901 COVID19 DNA/RNA HITHRPUT 1,888 $99.00
998389 LVL 2 FREE STD EMER DEPT 1,727 $2,216.25
898709 CHEST XRAY 1 V 1,550 $1,352.80
998572 EKG TRACING ONLY 1,447 $994.81
999053 LIPASE 1,386 $518.85
999103 UA W MICRO AUTO 1,354 $358.84
998776 BMP TOTAL CALCIUM 1,233 $652.56
999101 TROPONIN QUANT 1,218 $775.35
950894 ONDANSETRON 4 MG VL 1,196 $256.22
907251 KETOROLAC 15 MG INJ 1,167 $28.56
998535 IVP EA ADD SEQ NEW DRUG 1,153 $660.73
999038 HCG QUALITATIVE SERUM 1,073 $350.07
999104 UA W O MICRO AUTO 1,021 $229.47
943382 LOCM 300-399 IC 1ML 992 $0.85
889044 NS 50 ML 883 $716.68
998532 IV HYDRAT EA ADD HR 805 $621.32
998436 ED PROC CAT 2 745 $2,718.26
998481 INJECTION IM OR SQ 714 $389.88

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