Emergency visit, high (level 4) at HSHS St. Clare Memorial Hospital. CPT 99284.
What HSHS St. Clare Memorial Hospital publishes for this service, straight from its standard-charges file, last updated March 24, 2026.
Outpatient / ER
$539cash price (self-pay)
$816list price
$196–$816range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | Aetna Medicare | $196 |
| Anthem | Anthem Medicare Advantage HMO | $196 |
| Humana | Humana Medicare Advantage | $196 |
| Molina Healthcare | Molina Medicare | $196 |
| United Healthcare | United Health Care Medicare | $196 |
| Security Health Plan | Medicare Advantage Security Health Plan Of Wi | $198 |
| Hshs Employees | Hshs Employees | $397 |
| Molina Healthcare Of Wi | All Commerical Molina Marketplace | $408 |
| Unity Health Plan | Unity Hospice | $426 |
| Naphcare | All Commerical Naphcare | $441 |
| Cigna | All Commercial Cigna | $510 |
| Security Health Plan | All Commercial Security Health Plan Broad Netwo | $521 |
| Triology | All Commercial Triology | $645 |
| Arise Health Plan | All Commercial Arise Health Plan | $653 |
| Health Care Alliance | The Alliance | $685 |
| Choicecare | All Commercial Choice Care | $694 |
| Humana | All Commercial Humana Hpn Choicecare | $694 |
| Humana | Humana Choice Care PPO | $694 |
| Humana | Humana Natiional POS HMO | $694 |
| Health Eos | All Commercial Health Eos | $726 |
| Multiplan/Phcs | All Commercial Multiplan | $726 |
| Cofinity | Cofinity | $734 |
| Interplan | All Commercial Interplan Health Group | $734 |
| Network Health Plan | All Commerical Network Health Plan | $734 |
| North Central Healthcare Alliance | Neha | $751 |
| First Health | All Commercial First Health Network | $775 |
| Wea Provider Network | Wea Insurance Corporation | $775 |
| Aetna | All Commercial Aetna | $816 |
| Anthem | Anthem POS/HMO | $816 |
| Anthem | Anthem PPO | $816 |
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