Emergency visit, high (level 4) at Fairview Hospital. CPT 99284.
What Fairview Hospital publishes for this service, straight from its standard-charges file, last updated March 25, 2026.
Outpatient / ER
$586cash price (self-pay)
$1,737list price
$87.75–$1,650range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicare | MCR Traditional Medicare | $123 |
| Medicare | MCRManaged Medicare HMO | $123 |
| Hospice | Comm Hospice | $125 |
| Other Government | MCR Miscellaneous | $125 |
| Other Government | MCRManaged USA Family | $125 |
| Other Government | MCRManaged VA | $125 |
| Health New England | MCRManaged HNE Medicare Advantage | $127 |
| Blue Cross | MCRManaged Blue Cross VT Medicare HMO | $134 |
| Fallon | MCRManaged Fallon Medicare Advantage | $134 |
| CommCare Alliance | MCRManaged CCA One Care | $139 |
| Fallon | MCRManaged Fallon Medicare SCO | $145 |
| Other Government | Tri Tricare | $175 |
| Point32Health | Comm Tufts QHPSUB (Network) | $222 |
| Point32Health | MCDManaged Tufts (Network) | $222 |
| Workers Comp | WC Workers Comp | $253 |
| Comm Fallon QHP | Comm Fallon QHP | $278 |
| Aetna | Comm Aetna | $288 |
| Unicare | Comm Wellpoint (Unicare) | $316 |
| Comm HNE HMO | Comm HNE HMO | $322 |
| Health New England | Comm HNE | $342 |
| Comm HNE PPO | Comm HNE PPO | $343 |
| Fallon | MCDManaged Fallon Medicaid ACO | $474 |
| Allways NHP | Comm NHP | $761 |
| United Healthcare | Comm United BH | $765 |
| Point32Health | Comm Tufts QHPNONSUB (Network) | $777 |
| Blue Cross | Comm Blue Cross VT PPO | $887 |
| Point32Health | Comm Tufts | $932 |
| United Healthcare | Comm UnitedHealthcare | $1,012 |
| Capital District Physicians' Health Plan | Comm CDPHP | $1,059 |
| Cigna | Comm Cigna Carelink | $1,059 |
Inpatient
$586cash price (self-pay)
$1,177list price
$348–$1,650range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Point32Health | Comm Tufts QHPSUB (Network) | $665 |
| Point32Health | MCDManaged Tufts (Network) | $665 |
| Workers Comp | WC Workers Comp | $750 |
| Allways NHP | Comm NHP | $761 |
| Point32Health | Comm Tufts QHPNONSUB (Network) | $763 |
| United Healthcare | Comm United BH | $765 |
| Blue Cross | Comm Blue Cross VT PPO | $847 |
| Aetna | Comm Aetna | $888 |
| Point32Health | Comm Tufts | $932 |
| United Healthcare | Comm UnitedHealthcare | $1,012 |
| Capital District Physicians' Health Plan | Comm CDPHP | $1,059 |
| MVP | Comm MVP | $1,059 |
| Oxford | Comm Oxford | $1,059 |
| Connecticare | Comm Connecticare | $1,118 |
| Consolidated Health Plans | Comm Consolidated Health | $1,118 |
| First Health | Comm First Health | $1,118 |
| Point32Health | Comm Harvard | $1,118 |
| Other Commercial | Comm Other | $1,118 |
| PHCS | Comm PHCS | $1,118 |
| Self Pay | Comm Self Pay | $1,118 |
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