Emergency visit, high (level 4) at HSHS St. Mary's Hospital Medical Center. CPT 99284.
What HSHS St. Mary's Hospital Medical Center publishes for this service, straight from its standard-charges file, last updated March 24, 2026.
Outpatient / ER
$1,259cash price (self-pay)
$1,908list price
$407–$1,908range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | Aetna Medicare | $407 |
| Anthem | Anthem Medicare Advantage HMO | $407 |
| Humana | Humana Medicare Advantage | $407 |
| Medicare Managed | Managed Medicare No Sequestration | $407 |
| Molina Healthcare | Molina Medicare | $407 |
| United Healthcare | United Health Care Medicare | $407 |
| Security Health Plan | Medicare Advantage Security Health Plan Of Wi | $412 |
| Naphcare | All Commerical Naphcare | $917 |
| Hshs Employees | Hshs Employees | $927 |
| Molina Healthcare Of Wi | All Commerical Molina Marketplace | $954 |
| Security Health Plan | All Commercial Security Health Plan Broad Netwo | $1,218 |
| Cigna | All Commercial Cigna | $1,336 |
| Health Eos | All Commercial Health Eos | $1,355 |
| Triology | All Commercial Triology | $1,374 |
| Healthsmart | All Commercial Healthsmart | $1,393 |
| Interplan | All Commercial Interplan Health Group | $1,393 |
| Network Health Plan | All Commerical Network Health Plan | $1,431 |
| Health Care Alliance | The Alliance | $1,603 |
| Multiplan/Phcs | All Commercial Multiplan | $1,603 |
| Choicecare | All Commercial Choice Care | $1,622 |
| Humana | All Commercial Humana Hpn Choicecare | $1,622 |
| Humana | Humana Choice Care PPO | $1,622 |
| North Central Healthcare Alliance | Neha | $1,755 |
| First Health | All Commercial First Health Network | $1,813 |
| Aetna | Aetna Hshs | $1,908 |
| Aetna | All Commercial Aetna | $1,908 |
| Anthem | Anthem POS/HMO | $1,908 |
| Anthem | Anthem PPO | $1,908 |
| Caterpillar, Inc. | UHC Caterpillar Employer Group | $1,908 |
| Cenpatico | All Medicaid Cenpatico | $1,908 |
Billed more than this?
Scan my billSnap a photo of your bill. We compare every line with these prices and coding rules, free.
All common services at HSHS St. Mary's Hospital Medical Center