Emergency visit, high (level 4) at Gundersen Palmer Lutheran Hospital and Clinic. CPT 99284.
What Gundersen Palmer Lutheran Hospital and Clinic publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$522cash price (self-pay)
$878list price
$371–$878range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Products | $371 |
| Quartz | All Other Self Funded | $386 |
| Quartz | Self Funded | $413 |
| Quartz | Level Funded | $426 |
| UHC | All Payer Appendix | $435 |
| Health Partners | Medicaid HMO | $439 |
| Wellmark | All Products | $448 |
| Aetna | Medicare Advantage | $457 |
| Amerigroup | Medicare Advantage | $457 |
| Health Partners | Medicare Advantage | $457 |
| Humana | Medicare Advantage | $457 |
| Iowa Total Care | Medicaid | $457 |
| Managed Health Service | Managed Medicaid | $457 |
| Quartz | Medicaid_Badgercare | $457 |
| Quartz | Medicare Advantage | $457 |
| UHC | Medicare Advantage | $457 |
| Wellmark | Medicare Advantage | $457 |
| Quartz | Fully Insured | $479 |
| UCARE | Dually Eligible | $483 |
| UCARE | Non-Dually Eligible | $483 |
| UCARE | MSHO/Minnesota Special Needs | $483 |
| Health Partners | Medicare Cost | $527 |
| Alliance | Premier/All Products | $695 |
| Alliance | Comprehensive/All Products | $695 |
| Medical Associates | CAH Specific | $702 |
| Trilogy | All Products | $702 |
| UCARE | Qualified Health Plan | $702 |
| Aetna | All Products | $720 |
| Aspirus Arise Health | All Products | $729 |
| Allied National | Core Value Programs | $746 |
Inpatient
$522cash price (self-pay)
$878list price
$371–$852range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Other Self Funded | $517 |
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All common services at Gundersen Palmer Lutheran Hospital and Clinic