Emergency visit, high (level 4) at Franciscan Health Lafayette. CPT 99284.
What Franciscan Health Lafayette publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$662cash price (self-pay)
$2,994list price
$296–$3,528range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicaid Illinois [1091] | In Mcd-Wir-Lafayette | $296 |
| Medicaid [1092] | In Mcd-Wir-Lafayette | $296 |
| Mdwise [1175] | In Mcd-Wir-Lafayette | $296 |
| Alt Traditional Medicaid Secondary [109200] | In Mcd-Wir-Lafayette | $296 |
| Managed Health Services [1302] | In Mcd Lafayette Mhs 112% Of In Mcd | $305 |
| Medicaid [1092] | In Mcd Lafayet Caresource 120% Of In Mcd | $355 |
| Medicare [1099] | Medicare-Wir-Lafayette | $441 |
| Medicare Replacement [2003] | Medicare-Wir-Lafayette | $441 |
| Workers Comp [1172] | Workers Comp - Wir - Lafayette | $883 |
| Blue Cross [1014] | Anthem Franciscan Employee Copps- All Locations | $1,068 |
| Aetna [1005] | Aetna-Nid-Dyer-Munster-Crn Point | $1,228 |
| Managed Care [2000] | Aetna-Nid-Dyer-Munster-Crn Point | $1,228 |
| Blue Cross [1014] | Anthem Healthsync HMO With Copps - Lafayette | $1,291 |
| United Healthcare [1156] | United Healthcare Charter-Wid-Lafayette | $1,302 |
| United Healthcare [1156] | UHC All Payer-Wid-Lafayette | $1,446 |
| United Medical Resources [1158] | UHC All Payer-Wid-Lafayette | $1,446 |
| United Medical Resources [1301] | UHC All Payer-Wid-Lafayette | $1,446 |
| Managed Care [2000] | UHC All Payer-Wid-Lafayette | $1,446 |
| Commercial [2001] | UHC All Payer-Wid-Lafayette | $1,446 |
| Blue Cross [1014] | Anthem Healthsync POS With Copps - Lafayette | $1,462 |
| United Healthcare [1156] | United Healthcare Options PPO-Wid-Lafaye | $1,593 |
| United Medical Resources [1301] | United Healthcare Options PPO-Wid-La | $1,593 |
| Managed Care [2000] | United Healthcare Options PPO-Wid-Lafaye | $1,593 |
| Blue Cross [1014] | Anthem Blue Access PPO With Copps - Lafayette | $1,634 |
| Unicare [1150] | Anthem Blue Access PPO With Copps - Lafayette | $1,634 |
| Blue Cross Illinois [1210] | Anthem Blue Access PPO With Copps - Lafay | $1,634 |
| Blue Cross Out Of State [1211] | Anthem Blue Access PPO With Copps - L | $1,634 |
| Alt Payer Illinois Blue Cross [121002] | Anthem Blue Access PPO With C | $1,634 |
| Alt Payer Indiana Blue Cross [121003] | Anthem Blue Access PPO With Co | $1,634 |
| Managed Care [2000] | Encore - Cid & Nid & Wid & Sscd | $1,946 |
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