Emergency visit, high (level 4) at Gundersen St. Elizabeth Hospital and Clinics. CPT 99284.
What Gundersen St. Elizabeth Hospital and Clinics publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$787cash price (self-pay)
$1,292list price
$86.59–$1,848range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Medicaid | $86.59 |
| Group Health of South Central | Medicaid HMO | $86.59 |
| Iowa Total Care | Medicaid | $86.59 |
| Managed Health Service | Managed Medicaid | $86.59 |
| Quartz | Medicaid_Badgercare | $86.59 |
| South County | Managed Medicaid | $86.59 |
| Bcbsmn | Mhcp | $320 |
| Medica | AccessAbilty Solution | $491 |
| Medica | Minnesota Care | $491 |
| Quartz | All Products | $547 |
| Quartz | All Other Self Funded | $568 |
| Quartz | Self Funded | $607 |
| Quartz | Level Funded | $627 |
| Health Partners | Medicaid HMO | $646 |
| Aetna | Medicare Advantage | $698 |
| Quartz | Fully Insured | $704 |
| Medica | Medicare Advantage | $711 |
| Health Partners | Medicare Cost | $775 |
| Anthem | Medicare HMO/PPO | $840 |
| Health Partners | Medicare Advantage | $840 |
| Humana | Medicare Advantage | $840 |
| Quartz | Medicare Advantage | $840 |
| South County | Managed Medicare | $840 |
| UCARE | Dually Eligible | $840 |
| UCARE | Non-Dually Eligible | $840 |
| BCBSMN | All Products | $889 |
| Alliance | Premier/All Products | $1,020 |
| Alliance | Comprehensive/All Products | $1,020 |
| Group Health of South Central | All Products | $1,034 |
| Trilogy | All Products | $1,034 |
Inpatient
$787cash price (self-pay)
$1,292list price
$320–$1,240range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Other Self Funded | $761 |
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All common services at Gundersen St. Elizabeth Hospital and Clinics