Emergency visit, highest (level 5) at Intermountain Health Primary Children's Hospital. CPT 99285.
What Intermountain Health Primary Children's Hospital publishes for this service, straight from its standard-charges file, last updated August 5, 2026.
Outpatient / ER
$2,800cash price (self-pay)
$3,734list price
$173–$3,286range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| American Health | Medicare Adv UT HMO I-SNP | $173 |
| Health Plan of Nevada | Medicaid | $173 |
| Healthy U | Medicaid | $173 |
| Molina | Medicaid | $173 |
| Molina | Medicare Advantage | $173 |
| Molina | Medicare Choice Care HMO | $173 |
| Molina | Medicare Complete Care HMO SNP | $173 |
| Southwest Behavioral Health | Behavioral Health | $173 |
| UHC | Medicare Advantage | $173 |
| SelectHealth | Medicaid | $261 |
| Donor Connect | Other | $1,486 |
| Aetna | Standard | $3,136 |
| BYU Athletics | Commercial | $3,136 |
| Campbell Scientific | Commercial | $3,136 |
| Cigna | HMO | $3,136 |
| Cigna | Open Access Flex | $3,136 |
| Cigna | PPO/EPO | $3,136 |
| Cigna | Utah Connect/Local Plus | $3,136 |
| Deseret Mutual | All Other | $3,136 |
| EMI Health | Mint | $3,136 |
| EMI Health | Network Care | $3,136 |
| EMI | Commercial | $3,136 |
| First Choice of the Midwest | Commercial | $3,136 |
| First Choice | Commercial | $3,136 |
| Franklin County | Commercial | $3,136 |
| Global Excel | Commercial | $3,136 |
| Health Utah | Commercial | $3,136 |
| Humana | Commercial | $3,136 |
| Hygeia Corporation | Commercial | $3,136 |
| Juniper Systems | Commercial | $3,136 |
Inpatient
$2,800cash price (self-pay)
$3,734list price
$1,344–$3,286range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Donor Connect | Other | $1,344 |
| American Health | Medicare Adv UT HMO I-SNP | $2,128 |
| Molina | Medicare Advantage | $2,240 |
| Molina | Medicare Choice Care HMO | $2,240 |
| Molina | Medicare Complete Care HMO SNP | $2,240 |
| AWH Connected | Connected Utah | $2,651 |
| Aetna | Connected | $2,651 |
| Aetna | Extended | $2,651 |
| Aetna | Standard | $2,651 |
| BYU Athletics | Commercial | $2,651 |
| Campbell Scientific | Commercial | $2,651 |
| Cigna | HMO | $2,651 |
| Cigna | Open Access Flex | $2,651 |
| Cigna | PPO/EPO | $2,651 |
| Cigna | Utah Connect/Local Plus | $2,651 |
| Deseret Mutual | All Other | $2,651 |
| EMI Health | Mint | $2,651 |
| EMI Health | Network Care | $2,651 |
| EMI | Commercial | $2,651 |
| First Choice of the Midwest | Commercial | $2,651 |
| First Choice | Commercial | $2,651 |
| Franklin County | Commercial | $2,651 |
| Global Excel | Commercial | $2,651 |
| Health Utah | Commercial | $2,651 |
| Humana | Commercial | $2,651 |
| Hygeia Corporation | Commercial | $2,651 |
| Juniper Systems | Commercial | $2,651 |
| LW Miller | Commercial | $2,651 |
| Managed Care Admin | Commercial | $2,651 |
| MedCare International | Commercial | $2,651 |
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All common services at Intermountain Health Primary Children's Hospital