Emergency visit, high (level 4) at Bellin Memorial Hospital. CPT 99284.
What Bellin Memorial Hospital publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$614cash price (self-pay)
$1,326list price
$209–$1,632range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Healthpartners | Select | $209 |
| AETNA | Medicare | $405 |
| ANTHEM | Managed Medicare | $405 |
| COMMUNITY CARE | Medicare Advantage | $405 |
| HUMANA | Medicare Advantage | $405 |
| ICARE | Managed Medicare | $405 |
| Managed Health Service | Medicare Advantage | $405 |
| My Choice | Medicare Advantage | $405 |
| Network Health | Medicare Advantage | $405 |
| Security Health Plan | Medicare Advantage | $405 |
| Healthpartners | Focus | $413 |
| United Health Care | Medicare Advantage | $422 |
| WPS Insurance | BROAD | $423 |
| Healthpartners | Broad | $446 |
| Chorus Community Health Plan | ALL PRODUCTS | $853 |
| Aspirus Arise | ALL PRODUCTS | $889 |
| Cigna Health and Life Insurance Company | ALL PRODUCTS | $926 |
| United Health Care | PPO Options | $927 |
| HPS/Paymedix | Medical Rental Network Tier 1 | $955 |
| Security Health Plan | All Products | $1,008 |
| Trilogy | MEDICAL RENTAL | $1,008 |
| HPS/PayMedix | Medical Rental Network Tier 2 | $1,034 |
| Evernorth | Behavioral Health | $1,061 |
| HEALTHSMART | Medical Rental Network | $1,061 |
| IHS(ClaimsBridge) | Medical Rental Network | $1,061 |
| Medical College of WI | Self-funded employer | $1,061 |
| Multiplan/Healtheos | All Products | $1,061 |
| Allied National | Core Value Programs | $1,127 |
| FIRST HEALTH | Medical Rental Network | $1,127 |
| Galaxy Health | All Products | $1,127 |
Inpatient
$614cash price (self-pay)
$1,326list price
$853–$1,239range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Cigna Health and Life Insurance Company | ALL PRODUCTS | $936 |
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