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 June 12, 2021

Charge Description Average Charge per Account
Single or first dose of medication IV $533
Complete panel of 14 blood tests $733
Catheter needle used to start IV $14
1000 ML bag of saline IV fluid $786
External recording of electrical activity of heart $898
Blood test for pancreatic enzymes $482
Chest x-ray 1 view $1,188
Urine test conducted via machine with micro $923
Second or each additional dose of medication delivered via IV $769
15mg injection of Ketorolac, a non-steroid anti-inflammatory medication $26
Basic panel of 7 or 8 blood tests including CA $564
4mg vial of Ondansetron, used to prevent nausea and vomiting $245
Blood test for heart muscle $738
Blood test for pregnancy $320
Low osmolar contrast material used in diagnostic radiology $62
Urine test without microscope $213
Normal Saline 50 ml $646
Each additional hour of IV fluid hydration $622
ED PROC CAT 2 $2,480
Urine pregnancy test $191
Computerized tomography "Cat Scan" of the abdomen and pelvis with contrast $10,604
Acetamin 500mg $11
Intramuscular or subcutaneous injection $351
Ibuprofen 600 mg tablet $6
Antihistamine injection $134

View insurance options En Español


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 June 12, 2021

Charge Description Average Charge per Account
Catheter needle used to start IV $14
Single or first dose of medication IV $584
Complete panel of 14 blood tests $799
1000 ML bag of saline IV fluid $759
External recording of electrical activity of heart $832
Blood test for heart muscle $829
Basic panel of 7 or 8 blood tests including CA $630
Chest XRAY 1 view $1,183
Blood test for pancreatic enzymes $523
Second or each additional dose delivered IV $798
4mg vial of Ondansetron, used to prevent nausea and vomiting $236
15mg injection of Ketorolac, a non-steroid anti-inflammatory medication $25
Low osmolar contrast material used in diagnostic radiology $61
Urine test without microscope $233
Normal Saline 50ml $641
Blood test for pregnancy $343
Urine test conducted via machine with micro $362
ED PROC CAT 2 $2,712
Each additional hour of IV fluid hydration $653
Computerized tomography "Cat Scan" of the abdomen and pelvis with contrast $11,614
Drug test for controlled substances $1,608
Test for protein in blood clotting $953
Computerized tomography "Cat Scan" of the head without contrast $5,354
Puncture of a vein $85

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