Emergency visit, high (level 4) at Memorial Hospital of South Bend. CPT 99284.
What Memorial Hospital of South Bend publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$839cash price (self-pay)
$1,291list price
$239–$1,385range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| McLaren | MI Medicaid | $239 |
| UHC | MI Medicaid | $239 |
| Anthem | Commercial (Granger) | $336 |
| Devoted Healthcare | Medicare Advantage | $363 |
| Anthem | Exchange | $446 |
| Anthem | Medicare Advantage | $446 |
| Humana | Medicare Advantage | $446 |
| PACE | Medicare | $446 |
| UHC | Medicare Advantage | $446 |
| Aetna | Medicare Advantage | $514 |
| Caresource | Exchange | $714 |
| Anthem | HealthSync | $718 |
| CHA | Employer Group 4 | $775 |
| Immergrun | Commercial | $775 |
| MHS | Exchange | $821 |
| Anthem | Commercial (excludes Granger) | $822 |
| Anthem | Workers Compensation | $848 |
| Plain Church | Commercial | $851 |
| Cigna | OAP | $904 |
| UHC | Commercial | $932 |
| Aetna | Commercial | $950 |
| Multiplan | Commercial | $955 |
| CHA | Employer Group 5 | $968 |
| Humana | Commercial | $994 |
| CHA | Employer Group 6 | $1,033 |
| Cigna BH | Commercial | $1,033 |
| Cigna | PPO | $1,059 |
| Heartland | Hospice | $1,291 |
Inpatient
$839cash price (self-pay)
$1,291list price
$258–$1,059range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Devoted Healthcare | Medicare Advantage | $258 |
| Multiplan | Commercial | $839 |
| Cigna | OAP | $904 |
| UHC | Commercial | $932 |
| Humana | Commercial | $942 |
| Aetna | Commercial | $950 |
| CHA | Employer Group 5 | $968 |
| CHA | Employer Group 6 | $1,033 |
| Cigna BH | Commercial | $1,033 |
| Immergrun | Commercial | $1,033 |
| Plain Church | Commercial | $1,033 |
| Cigna | PPO | $1,059 |
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