Emergency visit, high (level 4) at Gundersen Boscobel Area Hospital and Clinic. CPT 99284.
What Gundersen Boscobel Area Hospital and Clinic publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$653cash price (self-pay)
$1,267list price
$536–$4,286range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Products | $536 |
| Quartz | All Other Self Funded | $557 |
| Quartz | Self Funded | $595 |
| Quartz | Level Funded | $615 |
| Anthem | Medicare HMO/PPO | $621 |
| Dean Health Plan | Medicare Select | $621 |
| Health Partners | Medicare Advantage | $621 |
| Humana | Medicare Advantage | $621 |
| Medical Associates | Medicare Advantage | $621 |
| Quartz | Medicare Advantage | $621 |
| Health Partners | Medicaid HMO | $634 |
| UCARE | Dually Eligible | $634 |
| UCARE | MSHO/Minnesota Special Needs | $634 |
| UCARE | Non-Dually Eligible | $634 |
| Quartz | Fully Insured | $691 |
| Health Partners | Medicare Cost | $760 |
| WPS | All Products | $765 |
| Dean Health Plan | All Products | $962 |
| Medical Associates | All Products | $963 |
| UHC | All Payer Appendix | $969 |
| Cigna | All Products | $977 |
| Alliance | Comprehensive/All Products | $1,014 |
| Alliance | Premier/All Products | $1,014 |
| Group Health of South Central | All Products | $1,014 |
| Medical Associates | CAH Specific | $1,014 |
| Trilogy | All Products | $1,014 |
| UCARE | Qualified Health Plan | $1,014 |
| Aspirus Arise Health | All Products | $1,052 |
| Sana | All Products | $1,090 |
| Multiplan/Healtheos | Mpi_phcs_healtheos | $1,115 |
Inpatient
$653cash price (self-pay)
$1,267list price
$536–$1,216range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Other Self Funded | $746 |
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All common services at Gundersen Boscobel Area Hospital and Clinic