Emergency visit, high (level 4) at Gundersen Lutheran Medical Center. CPT 99284.
What Gundersen Lutheran Medical Center publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$173–$834range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Bcbsmn | Mhcp | $173 |
| UCARE | Non-Dually Eligible | $422 |
| UCARE | Dually Eligible | $422 |
| Aetna | Medicare Advantage | $442 |
| Amerigroup | Medicare Advantage | $442 |
| Anthem | Medicare HMO/PPO | $442 |
| Health Partners | Medicare Advantage | $442 |
| iCare | Medicare Advantage | $442 |
| Medical Associates | Medicare Advantage | $442 |
| Quartz | Medicare Advantage | $442 |
| UHC | Medicare Advantage | $442 |
| UCARE | MSHO/Minnesota Special Needs | $443 |
| BCBSMN | All Products | $834 |
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