NOTICE REGARDING HEALTH CARE PLAN COVERAGE

This freestanding emergency department (Belmar 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 $844.01 to $13,108.56. 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) 475-1385 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.

Belmar Emergency Department

Updated January 11, 2021

Charge Description Average Charge per Account
Single or first dose of medication IV $500
1000 ML bag of saline IV fluid $707
Catheter needle used to start IV $13
Complete panel of 14 blood tests $692
Each additional hour of IV fluid hydration $531
Blood test for pancreatic enzymes $447
Urine test conducted via machine with micro $313
Second or each additonal dose delivered IV $702
Basic panel of 7 or 8 blood tests including CA $531
Blood test for pregnancy $298
Chest XRAY 1 view $1,068
15mg injection of Ketorolac, a non-steroid anti-inflammatory medication $24
4mg vial of Ondansetron, used to prevent nausea and vomiting $229
External recording of electrical activity of heart $832
Blood test for heart muscle $691
Urine test without microscope $202
IBUPROFEN 600MG TAB $5
Low osmolar contrast material used in diagnostic radiology $1,067
Rapid stress test to diagnose strep throat $117
Computerized tomography "Cat Scan" of the abdomen and pelvis with contrast $9,838
Acetaminophen 500 mg tablet $10
ED PROC CAT 2 $2,376
Intramuscular subqutaneous injection $315
Culture for group A strep $343
Urine pregnany test $174

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NOTICE REGARDING HEALTH CARE PLAN COVERAGE

This freestanding emergency department (Southwest 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 $844.01 to $13,108.56. 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) 475-1385 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.

Southwest Emergency Department

Updated January 11, 2021

Charge Description Average Charge per Account
1000 ML bag of saline IV fluid $705
Single or first dose of medication IV $549
Complete panel of 14 blood tests $758
Catheter needle used to start IV $13
External recording of electrical activity of heart $810
Blood test for pancreatic enzymes $490
Basic panel of 7 or 8 blood tests including CA $599
Each additional hour of IV fluid hydration $639
Second or each additonal dose delivered IV $754
Blood test for heart muscle $758
Chest XRAY 1 view $1,073
4mg vial of Ondansetron, used to prevent nausea and vomiting $224
15mg injection of Ketorolac, a non-steroid anti-inflammatory medication $24
Blood test for pregnancy $331
Urine test conducted via machine with micro $338
Low osmolar contrast material used in diagnostic radiology $146
Urine test without microscope $218
Normal Saline 50ml $591
ED PROC CAT 2 $2,585
Acetaminophen 500 mg tablet $10
Computerized tomography "Cat Scan" of the abdomen and pelvis with contrast $10,786
Collection of blood from a vein $80
Intramuscular subqutaneous injection $352
DRUG TEST DEF 1-7 CLASS $1,417
Computerized tomography "Cat Scan" of the head/brain without contrast $4,990

View insurance options En Español

Contracted Plans

PlanCommercial Group and IndividualManaged MedicareManaged Medicaid
AETNA (Inc. Coventry and FirstHealth) All Networks All Networks N/A
Anthem BCBS All Networks All Networks N/A
BrightHealth All Networks (Emergency Only) Not participating N/A
CIGNA All Networks All Networks N/A
Clear Spring N/A All Networks N/A
Colorado Access N/A N/A All Networks
Friday Health Plan Not Participating N/A N/A
Humana Not participating All Networks N/A
InnoVage N/A All Networks N/A
Kaiser All Networks (All FSED Locations only) All Networks and locations N/A
Multiplan/PHCS All Hospital Networks (excluding physician only networks) N/A N/A
Mutual of Omaha N/A All Networks N/A
OSCAR All Networks N/A N/A
Rocky Mountain Health Plan All Networks All Networks All Networks
UnitedHealthcare All Networks (except Colorado Doctors Plan) All Networks N/A

Swedish 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 Swedish Medical Center, Swedish Southwest ER and Swedish Belmar 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: $844.01
  • Level 2: $2,052.08
  • Level 3: $4,660.93
  • Level 4: $7,810.21
  • Level 5: $13,108.56