Emergency visit, high (level 4) at Gundersen Moundview Hospital and Clinics. CPT 99284.
What Gundersen Moundview Hospital and Clinics publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$688cash price (self-pay)
$1,354list price
$573–$4,286range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Products | $573 |
| Quartz | All Other Self Funded | $596 |
| Security Health Plan | Medicare Advantage | $623 |
| Anthem | Medicare HMO/PPO | $623 |
| Health Partners | Medicare Advantage | $623 |
| Quartz | Medicare Advantage | $623 |
| Security Health Plan | Medicare + Choice | $623 |
| UCARE | Dually Eligible | $623 |
| Quartz | Self Funded | $636 |
| UCARE | MSHO/Minnesota Special Needs | $650 |
| UCARE | Non-Dually Eligible | $650 |
| Quartz | Level Funded | $657 |
| Health Partners | Medicaid HMO | $677 |
| Quartz | Fully Insured | $738 |
| UHC | All Payer Appendix | $796 |
| Health Partners | Medicare Cost | $812 |
| WPS | All Products | $1,044 |
| WPS - ARISE | All Products | $1,044 |
| Cigna | All Products | $1,044 |
| Dean Health Plan | ASO | $1,063 |
| Alliance | Premier/All Products | $1,083 |
| Alliance | Comprehensive/All Products | $1,083 |
| Group Health of South Central | All Products | $1,083 |
| Trilogy | All Products | $1,083 |
| UCARE | Qualified Health Plan | $1,083 |
| Aspirus Arise Health | All Products | $1,124 |
| Sana | All Products | $1,164 |
| Multiplan/Healtheos | Mpi_phcs_healtheos | $1,192 |
| Health Partners | All Products | $1,196 |
| Group Health Eau Claire | All Products | $1,219 |
Inpatient
$688cash price (self-pay)
$1,354list price
$573–$1,313range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Other Self Funded | $798 |
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All common services at Gundersen Moundview Hospital and Clinics