Emergency visit, high (level 4) at Grand Itasca Clinic and Hospital. CPT 99284.
What Grand Itasca Clinic and Hospital publishes for this service, straight from its standard-charges file, last updated January 28, 2026.
Outpatient / ER
$228cash price (self-pay)
$1,244list price
$81.32–$1,262range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross of Minnesota | PMAP | $204 |
| Medica | Managed Medicaid | $263 |
| Medica | AccessAbility | $286 |
| Itasca Medical Care | Managed Medicaid | $397 |
| Primewest | Managed Medicaid | $397 |
| Itasca Medical Care | Medicare Advantage/MSHO | $429 |
| Primewest | MSHO | $429 |
| Sanford Health Plan | Medicare Advantage | $429 |
| Security Health Plan | Medicare Advantage | $429 |
| UCare | Medicare Advantage/MSHO | $429 |
| United Healthcare | Medicare Advantage | $429 |
| WellCare | Medicare Advantage | $429 |
| Blue Cross of Minnesota | Medicare Advantage | $446 |
| Health Partners | Medicare Advantage | $454 |
| Medica | Medicare Advantage Non-SNP | $454 |
| UCare | PMAP | $457 |
| Medica | MSHO-Dual/Medicare Advantage SNP | $510 |
| Blue Cross of Minnesota | Aware Federal | $539 |
| Blue Cross of Minnesota | Aware/Blue Plus | $549 |
| Health Partners | Medicare Cost | $648 |
| Health Partners | PMAP | $660 |
| Sanford Health Plan | Commercial | $733 |
| Medica | Commercial | $770 |
| United Healthcare | Commercial | $813 |
| UCare | Individual and Family Plans | $841 |
| Security Health Plan | Commercial | $933 |
| First Health | Commercial | $1,020 |
| Health Partners | Federal | $1,025 |
| Health Partners | Commercial | $1,043 |
| MultiPlan | Commercial | $1,058 |
Inpatient
$516cash price (self-pay)
$1,245list price
$553–$1,243range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Partners | Medicare Cost | $566 |
| Health Partners | PMAP | $576 |
| Sanford Health Plan | Commercial | $733 |
| Security Health Plan | Commercial | $933 |
| Health Partners | Federal | $973 |
| Health Partners | Commercial | $991 |
| United Healthcare | Commercial | $1,000 |
| First Health | Commercial | $1,021 |
| Medica | Commercial | $1,035 |
| Health Partners | Cigna Commercial | $1,040 |
| MultiPlan | Commercial | $1,058 |
| Private Healthcare Systems | Commercial | $1,058 |
| Wisconsin Physician Services | Commercial | $1,120 |
| America's PPO | Commercial/EZCare/Health EZ | $1,145 |
| Health Partners | Cigna Great West | $1,238 |
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