Emergency visit, high (level 4) at Intermountain Health Primary Children's Hospital. CPT 99284.
What Intermountain Health Primary Children's Hospital publishes for this service, straight from its standard-charges file, last updated August 5, 2026.
Outpatient / ER
$1,867cash price (self-pay)
$2,489list price
$119–$2,190range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| American Health | Medicare Adv UT HMO I-SNP | $119 |
| Health Plan of Nevada | Medicaid | $119 |
| Healthy U | Medicaid | $119 |
| Molina | Medicaid | $119 |
| Molina | Medicare Advantage | $119 |
| Molina | Medicare Choice Care HMO | $119 |
| Molina | Medicare Complete Care HMO SNP | $119 |
| Southwest Behavioral Health | Behavioral Health | $119 |
| UHC | Medicare Advantage | $119 |
| SelectHealth | Medicaid | $181 |
| Donor Connect | Other | $991 |
| Aetna | Standard | $2,091 |
| BYU Athletics | Commercial | $2,091 |
| Campbell Scientific | Commercial | $2,091 |
| Cigna | HMO | $2,091 |
| Cigna | Open Access Flex | $2,091 |
| Cigna | PPO/EPO | $2,091 |
| Cigna | Utah Connect/Local Plus | $2,091 |
| Deseret Mutual | All Other | $2,091 |
| EMI Health | Mint | $2,091 |
| EMI Health | Network Care | $2,091 |
| EMI | Commercial | $2,091 |
| First Choice of the Midwest | Commercial | $2,091 |
| First Choice | Commercial | $2,091 |
| Franklin County | Commercial | $2,091 |
| Global Excel | Commercial | $2,091 |
| Health Utah | Commercial | $2,091 |
| Humana | Commercial | $2,091 |
| Hygeia Corporation | Commercial | $2,091 |
| Juniper Systems | Commercial | $2,091 |
Inpatient
$1,867cash price (self-pay)
$2,489list price
$896–$2,190range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Donor Connect | Other | $896 |
| American Health | Medicare Adv UT HMO I-SNP | $1,419 |
| Molina | Medicare Advantage | $1,494 |
| Molina | Medicare Choice Care HMO | $1,494 |
| Molina | Medicare Complete Care HMO SNP | $1,494 |
| AWH Connected | Connected Utah | $1,767 |
| Aetna | Connected | $1,767 |
| Aetna | Extended | $1,767 |
| Aetna | Standard | $1,767 |
| BYU Athletics | Commercial | $1,767 |
| Campbell Scientific | Commercial | $1,767 |
| Cigna | HMO | $1,767 |
| Cigna | Open Access Flex | $1,767 |
| Cigna | PPO/EPO | $1,767 |
| Cigna | Utah Connect/Local Plus | $1,767 |
| Deseret Mutual | All Other | $1,767 |
| EMI Health | Mint | $1,767 |
| EMI Health | Network Care | $1,767 |
| EMI | Commercial | $1,767 |
| First Choice of the Midwest | Commercial | $1,767 |
| First Choice | Commercial | $1,767 |
| Franklin County | Commercial | $1,767 |
| Global Excel | Commercial | $1,767 |
| Health Utah | Commercial | $1,767 |
| Humana | Commercial | $1,767 |
| Hygeia Corporation | Commercial | $1,767 |
| Juniper Systems | Commercial | $1,767 |
| LW Miller | Commercial | $1,767 |
| Managed Care Admin | Commercial | $1,767 |
| MedCare International | Commercial | $1,767 |
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All common services at Intermountain Health Primary Children's Hospital