Emergency visit, high (level 4) at Ely Bloomenson Community Hospital. CPT 99284.
What Ely Bloomenson Community Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$777cash price (self-pay)
$1,033list price
$76.08–$1,107range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS Mcaid | BCBS Mcaid | $233 |
| Hpi/Cigna Mn Care | Hpi/Cigna Mn Care | $304 |
| Hpi/Cigna Mcr Adv | Hpi/Cigna Mcr Adv | $359 |
| UHC Mcr Adv | UHC Mcr Adv | $360 |
| BCBS Mcr Adv | BCBS Mcr Adv | $360 |
| Tricare/Triwest - All Plans | Tricare/Triwest - All Plans | $360 |
| UHC Va Ccn | UHC Va Ccn | $360 |
| Humana Choicecare Mcr Adv | Humana Choicecare Mcr Adv | $363 |
| Medica Msho Mcr Cost/Select | Medica Msho Mcr Cost/Select | $499 |
| Medica Mcr Adv | Medica Mcr Adv | $517 |
| BCBS / Blue Plus - All Other Plans | BCBS / Blue Plus - All Other Plan | $567 |
| UHC All Payer - All Other Plans | UHC All Payer - All Other Plans | $577 |
| Hpi/Cigna Medicare Cost | Hpi/Cigna Medicare Cost | $591 |
| UHC Mcaid | UHC Mcaid | $597 |
| Medica Mcaid Mn Care | Medica Mcaid Mn Care | $743 |
| First Health - All Plans | First Health - All Plans | $878 |
| Americas PPO - All Plans | Americas PPO - All Plans | $919 |
| Medica Comm - All Other Plans | Medica Comm - All Other Plans | $943 |
| Hpi/Cigna Comm - All Other Plans | Hpi/Cigna Comm - All Other Plans | $1,002 |
| Humana Choicecare Comm - All Other Plans | Humana Choicecare Comm - Al | $1,012 |
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