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 $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 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 10, 2022

Charge Description Average Charge per Account
Complete panel of 14 blood tests $764
Single or first dose of medication IV $601
Catheter needle used to start IV $15
1000 ML bag of saline IV fluid $790
Chest XRAY 1 view $1,266
External recording of electrical activity of heart $942
Urine test conducted via machine with micro $347
Blood test for pancreatic enzymes $495
Basic panel of 7 or 8 blood tests including CA $585
Blood test for heart muscle $798
4mg vial of Ondansetron, used to prevent nausea and vomiting $254
15mg injection of Ketorolac, a non-steroid anti-inflammatory medication $27
Second or each additional dose delivered IV $823
Blood test for pregnancy $333
Urine test without microscope $221
Low osmolar contrast material used in diagnostic radiology $66
Normal saline 50ml $684
Each additional hour of IV fluid hydration $719
Intramuscular or subcutaneous injection $392
ED PROC CAT 2 $2,609
Throat swab to check for Group A strep, the cause of strep throat $130
A sample of blood or other body fluid is taken to test for strep, staph, etc. $367
Acetamin 500mg $11
Urine pregnancy test $193
Computerized tomography "Cat Scan" of the abdomen and pelvis with contrast $10,838

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 $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 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 10, 2022

Charge Description Average Charge per Account
Complete panel of 14 blood tests $824
Single or first dose of medication IV $601
1000 ML bag of saline IV fluid $780
Catheter needle used to start IV $14
External recording of electrical activity of heart $927
Blood test for heart muscle $897
Chest XRAY 1 view $1,262
Basic panel of 7 or 8 blood tests including CA $644
Blood test for pancreatic enzymes $540
Second or each additional dose delivered IV $803
4mg vial of Ondansetron, used to prevent nausea and vomiting $256
Low osmolar contrast material used in diagnostic radiology $63
Normal saline 50ml $673
15mg injection of Ketorolac, a non-steroid anti-inflammatory medication $27
Urine test without microscope $240
Blood test for pregnancy $362
Urine test conducted via machine with microscope $377
Computerized tomography "Cat Scan" of the abdomen and pelvis with contrast $11,715
ED PROC CAT 2 $2,880
Each additional hour of IV fluid hydration $807
Computerized tomography "Cat Scan" of the head without contrast $5,696
Test to rule out blood clot $969
Drug test for controlled substances $1,971
Acetamin 500 mg tablet $12
Intramuscular or subcutaneous injection $388

View insurance options En Español

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 $911.53
  • Level 2 $2,216.25
  • Level 3 $5,033.80
  • Level 4 $8,435.03
  • Level 5 $14,157.24