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. In addition to facility 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
|CPT Code||Charge Description||Current Price|
|99283||LVL 3 FREE STD EMER DEPT||$5,537|
|99284||LVL 4 FREE STD EMER DEPT||$9,279|
|85027||COMPLETE CBC AUTOMATED||$250|
|80053||COMPREHEN METABOLIC PANEL||$845|
|96374||THER/PROPH/DIAG INJ IV PUSH||$706|
|71045||X-RAY EXAM CHEST 1 VIEW||$1,488|
|99282||LVL 2 FREE STD EMER DEPT||$2,438|
|87804||INFLUENZA ASSAY W/OPTIC||$152|
|81003||URINALYSIS AUTO W/O SCOPE||$243|
|84484||ASSAY OF TROPONIN QUANT||$822|
|96375||TX/PRO/DX INJ NEW DRUG ADDON||$727|
|83690||ASSAY OF LIPASE||$550|
|81001||URINALYSIS AUTO W/SCOPE||$380|
|80048||METABOLIC PANEL TOTAL CA||$692|
|84703||CHORIONIC GONADOTROPIN ASSAY||$371|
|96361||HYDRATE IV INFUSION ADD-ON||$683|
|96372||THER/PROPH/DIAG INJ SC/IM||$429|
|99281||LVL 1 FREE STD EMER DEPT||$1,003|
|74177||CT ABD & PELV W/CONTRAST||$12,340|
|81025||URINE PREGNANCY TEST||$216|
|87081||CULTURE SCREEN ONLY||$435|
|87426||SARSCOV CORONAVIRUS AG IA||$71|
|87430||STREP A AG IA||$142|
|87086||URINE CULTURE/COLONY COUNT||$483|