Emergency visit, high (level 4) at Gundersen St. Josephs Hospital and Clinic. CPT 99284.
What Gundersen St. Josephs Hospital and Clinic publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$602cash price (self-pay)
$1,145list price
$484–$4,500range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Products | $484 |
| Quartz | All Other Self Funded | $504 |
| Quartz | Self Funded | $538 |
| Quartz | Level Funded | $555 |
| Anthem | Medicare HMO/PPO | $584 |
| Dean Health Plan | Medicare Select | $584 |
| Humana | Medicare Advantage | $584 |
| Quartz | Medicare Advantage | $584 |
| UCARE | Dually Eligible | $584 |
| UHC | Medicare Advantage | $584 |
| UCARE | MSHO/Minnesota Special Needs | $595 |
| UCARE | Non-Dually Eligible | $595 |
| Quartz | Fully Insured | $624 |
| UHC | All Payer Appendix | $800 |
| Cigna | All Products | $883 |
| Alliance | Premier/All Products | $915 |
| Group Health of South Central | All Products | $916 |
| Trilogy | All Products | $916 |
| UCARE | Qualified Health Plan | $916 |
| Dean Health Plan | All Products | $920 |
| WPS | Narrow | $929 |
| Aspirus Arise Health | All Products | $950 |
| Alliance | Comprehensive/All Products | $972 |
| WPS | Broad | $972 |
| Allied National | Core Value Programs | $973 |
| Sana | All Products | $985 |
| Multiplan/Healtheos | Mpi_phcs_healtheos | $996 |
| Group Health Eau Claire | All Products | $1,031 |
| Security Health Plan | All Products | $1,031 |
| Coventry Health Care | All Products | $1,088 |
Inpatient
$602cash price (self-pay)
$1,145list price
$484–$1,088range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Other Self Funded | $674 |
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All common services at Gundersen St. Josephs Hospital and Clinic