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 |
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 |
Contracted Plans
Plan | Commercial Group and Individual | Managed Medicare | Managed 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 |