Emergency visit, high (level 4) at Intermountain Health Intermountain Medical Center. CPT 99284.
What Intermountain Health Intermountain Medical Center publishes for this service, straight from its standard-charges file, last updated August 5, 2026.
Outpatient / ER
$2,759cash price (self-pay)
$3,678list price
$119–$3,831range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Plan of Nevada | Medicaid | $408 |
| SelectHealth | Medicaid | $408 |
| Aetna | Medicare Adv HMO | $408 |
| Healthy U | Medicaid | $408 |
| Molina | Medicaid | $408 |
| TriWest | Veterans Choice | $408 |
| American Health | Medicare Adv UT HMO I-SNP | $422 |
| Health Partners of Nevada | Medicare Advantage | $422 |
| Humana | Medicare Choice PPO | $422 |
| Molina | Medicare Advantage | $422 |
| Molina | Medicare Choice Care HMO | $422 |
| Molina | Medicare Complete Care HMO SNP | $422 |
| Regence BCBS | MedAdvantage PPO | $422 |
| SelectHealth | Medicare Advantage | $422 |
| UHC | Medicare Advantage | $422 |
| SelectHealth | Signature Individual ACA | $433 |
| SelectHealth | Value Individual ACA | $433 |
| Aetna | Medicare Adv PPO | $449 |
| SelectHealth | Med Individual ACA | $474 |
| Donor Connect | Other | $861 |
| Deseret Mutual | All Other | $2,115 |
| Deseret Mutual | Select | $2,115 |
| AWH Connected | Connected Utah | $2,373 |
| Intermountain Caregiver Plan | Share Network | $2,462 |
| SelectHealth | SelectShare | $2,462 |
| SelectHealth | SelectValue | $2,462 |
| SelectHealth | FEHBP | $2,610 |
| AG Administrators | USU Athletics | $2,648 |
| BYU Athletics | Commercial | $2,648 |
| BYU Risk Management | Workers Comp | $2,648 |
Inpatient
$2,759cash price (self-pay)
$3,678list price
$44.14–$3,311range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Donor Connect | Other | $44.14 |
| Health Plan of Nevada | Medicaid | $1,104 |
| Intermountain Caregiver Plan | Med Network | $1,560 |
| Intermountain Caregiver Plan | Share Network | $1,560 |
| EMI | Commercial | $1,986 |
| Deseret Mutual | All Other | $2,115 |
| Deseret Mutual | Select | $2,115 |
| Regence BCBS | BlueOption | $2,271 |
| Regence BCBS | Cardiac Care | $2,271 |
| AWH Connected | Connected Utah | $2,336 |
| EMI Health | Mint | $2,553 |
| EMI Health | Network Care | $2,553 |
| PEHP | Advantage State | $2,560 |
| Corporation of the President | Workers Comp | $2,575 |
| Regence BCBS | High Performance | $2,575 |
| Regence BCBS | FEHBP | $2,593 |
| PEHP | Advantage Non-State | $2,612 |
| AG Administrators | USU Athletics | $2,648 |
| BYU Athletics | Commercial | $2,648 |
| BYU Risk Management | Workers Comp | $2,648 |
| Campbell Scientific | Commercial | $2,648 |
| CorVel Corporation | Workers Comp | $2,648 |
| Franklin County | Commercial | $2,648 |
| Juniper Systems | Commercial | $2,648 |
| LW Miller | Commercial | $2,648 |
| Injury Care of Nevada | Workers Comp | $2,759 |
| Regence BCBS | Traditional | $2,796 |
| Managed Care Admin | Commercial | $2,869 |
| Aetna | Connected | $2,943 |
| Molina | CHIP | $3,016 |
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