Emergency visit, high (level 4) at Essentia Health-Holy Trinity Hospital (Graceville). CPT 99284.
What Essentia Health-Holy Trinity Hospital (Graceville) publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$897cash price (self-pay)
$1,214list price
$426–$1,099range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Itasca Med Care | Medicaid | $426 |
| Primewest | Medicaid | $427 |
| HealthPartners CARE PMAP | Medicaid | $472 |
| Medica Access | Medicaid | $483 |
| Sanford HealthPlan | Commercial-NDPERS | $521 |
| Sanford HealthPlan | Commercial | $548 |
| BCBS Nd | BCBS Mn | $649 |
| HealthPartners | SHP | $738 |
| Advocare/Security Health | Medicare | $753 |
| BLUE CROSS MEDICARE ADVANTAGE CORE | Medicare | $753 |
| Freedom Blue PPO | Medicare | $753 |
| HEALTHPARTNERS CARE MSHO / MCR ADV | Medicare | $753 |
| IMCARE MSHO PCC PRIME | Medicare | $753 |
| IMCARE MSHO REF REQ | Medicare | $753 |
| MEDICA ADVANTAGE SOLUTIONS | Medicare | $753 |
| MEDICA MSHO/Dual Solutions | Medicare | $753 |
| MEDICA PRIME SOLUTION GROUP | Medicare | $753 |
| MEDICARE ADV PFFS | Medicare | $753 |
| ND VA ADMINISTRATION | Medicare | $753 |
| OUT OF STATE BCBS MEDICARE ADVANTAGE | Medicare | $753 |
| PRIMEWEST MSHO | Medicare | $753 |
| Platinum Blue/Vantage Blue | Medicare | $753 |
| SECURE BLUE MSHO | Medicare | $753 |
| SECURITY HEALTH MEDICARE | Medicare | $753 |
| UBH COST PLAN | Medicare | $753 |
| UBH MSHO/MEDICARE REPLACEMENT | Medicare | $753 |
| UBH MSHO | Medicare | $753 |
| Cigna | Commercial | $807 |
| HealthPartners PCC Prime | Commercial | $807 |
| HealthPartners | Commercial | $807 |
Inpatient
$897cash price (self-pay)
$1,214list price
$472–$1,099range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| HealthPartners CARE PMAP | Medicaid | $472 |
| Sanford HealthPlan | Commercial-NDPERS | $521 |
| Sanford HealthPlan | Commercial | $548 |
| BCBS MN | Medicaid | $668 |
| BLUE PLUS PMAP PCC PRIME | Medicaid | $668 |
| HealthPartners | SHP | $738 |
| Medica Access | Medicaid | $756 |
| Ucare | Commercial | $799 |
| Cigna | Commercial | $807 |
| HealthPartners PCC Prime | Commercial | $807 |
| HealthPartners | Commercial | $807 |
| MN BCBS Commercial | BCBS MN | $850 |
| WEA | Commercial-Narrow Network | $874 |
| WEA | Commercial | $935 |
| America's PPO | Commercial | $941 |
| WPS | Commercial | $1,008 |
| Medica Uplan | Commercial | $1,009 |
| Medica | Commercial-FI | $1,009 |
| Medica | Commercial-SI | $1,009 |
| Aetna First Health | Commercial | $1,032 |
| Medica | IFB ACO | $1,062 |
| Medica Choice | Commercial | $1,094 |
| UHC | Commercial | $1,099 |
| UMR | Commercial | $1,099 |
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All common services at Essentia Health-Holy Trinity Hospital (Graceville)