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Swedish Belmar ER Freestanding ED top charges

In compliance with federal law, please view pricing information for certain procedures and services at Swedish Belmar ER.

NOTICE REGARDING HEALTH CARE PLAN COVERAGE

This freestanding 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) 475-1385 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 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 April 4, 2023

CPT Code Charge Description Average Charge per Account
99283 LVL 3 FREE STD EMER DEPT $5,537
99284 LVL 4 FREE STD EMER DEPT $9,279
85027 COMPLETE CBC AUTOMATED $250
87804 INFLUENZA ASSAY W/OPTIC $152
80053 COMPREHEN METABOLIC PANEL $845
96374 THER/PROPH/DIAG INJ IV PUSH $706
71045 X-RAY EXAM CHEST 1 VIEW $1,488
81003 URINALYSIS AUTO W/O SCOPE $243
87426 SARSCOV CORONAVIRUS AG IA $71
93005 ELECTROCARDIOGRAM TRACING $1,074
99282 LVL 2 FREE STD EMER DEPT $2,438
96375 TX/PRO/DX INJ NEW DRUG ADDON $727
84484 ASSAY OF TROPONIN QUANT $822
84703 CHORIONIC GONADOTROPIN ASSAY $371
96372 THER/PROPH/DIAG INJ SC/IM $429
99281 LVL 1 FREE STD EMER DEPT $1,003
96361 HYDRATE IV INFUSION ADD-ON $683
80047 METABOLIC PANEL IONIZED CA $1,009
87081 CULTURE SCREEN ONLY $435
74177 CT ABD & PELV W/CONTRAST $12,340
81025 URINE PREGNANCY TEST $216
87880 STREP A ASSAY W/OPTIC $158
83690 ASSAY OF LIPASE $550
81001 URINALYSIS AUTO W/SCOPE $380
70450 CT HEAD/BRAIN W/O DYE $6,405

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Swedish Belmar 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 North Suburban Medical Center, Northwest ER and Northeast 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.

Freestanding Emergency Facility Fees
CPT Code Charge Description Average charge per account
99281 LVL 1 FREE STD EMER DEPT $1,003
99282 LVL 2 FREE STD EMER DEPT $2,438
99283 LVL 3 FREE STD EMER DEPT $5,537
99284 LVL 4 FREE STD EMER DEPT $9,279
99285 LVL 5 FREE STD EMER DEPT $15,573

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