Emergency visit, high (level 4) at Providence Medical Center. CPT 99284.
What Providence Medical Center publishes for this service, straight from its standard-charges file, last updated October 29, 2025.
Outpatient / ER
$643cash price (self-pay)
$692list price
$399–$890range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Molina Health (Healthy Blue) | Managed Medicaid | $408 |
| Nebraska Total Care | Managed Medicaid | $408 |
| United Healthcare Community Plan | Managed Medicaid | $408 |
| Medica | Commercial | $623 |
| Aetna | Commercial | $637 |
| Blue Cross Blue Shield | Commercial | $657 |
| Ambetter | Commercial | $664 |
| Multiplan | Commercial | $664 |
| Midland's Choice | Commercial | $678 |
| United Healthcare | Commercial | $678 |
Inpatient
$643cash price (self-pay)
$692list price
$609–$890range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medica | Commercial | $623 |
| Aetna | Commercial | $637 |
| Ambetter | Commercial | $664 |
| Multiplan | Commercial | $664 |
| Midland's Choice | Commercial | $678 |
| United Healthcare | Commercial | $678 |
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