Emergency visit, high (level 4) at Henry Ford Jackson Hospital. CPT 99284.
What Henry Ford Jackson Hospital publishes for this service, straight from its standard-charges file, last updated June 28, 2026.
Outpatient / ER
$179cash price (self-pay)
$401list price
$75.40–$1,669range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| HAP | HAP Caresource Medicaid-FAC | $75.40 |
| Aetna Better Health | Medicaid HMO-FAC | $79.17 |
| Blue Cross | Blue Cross Complete-Child-FAC | $79.17 |
| Blue Cross | Blue Cross Complete-Adult-FAC | $79.17 |
| Humana Military | Tricare-NonPhysician-NONFAC | $89.32 |
| Humana Military | Tricare-NonPhysician-FAC | $95.90 |
| HAP | Medicare Advantage HMO/PPO-NonPhysician-FAC | $101 |
| HAP | Medicare Advantage HMO/PPO-NonPhysician-NONFAC | $101 |
| Humana Military | Tricare-Physician-NONFAC | $111 |
| Humana Military | Tricare-Physician-FAC | $111 |
| Aetna | Medicare Advantage/Dual Products-FAC | $118 |
| Aetna | Medicare Advantage/Dual Products-NONFAC | $118 |
| Blue Cross | Medicare Plus Blue-NONFAC | $118 |
| Blue Cross | BCN Medicare Advantage -FAC | $118 |
| Blue Cross | Medicare Plus Blue-FAC | $118 |
| Blue Cross | BCN Medicare Advantage -NONFAC | $118 |
| Cascade Thome Pace | All Products-FAC | $118 |
| Cascade Thome Pace | All Products-NONFAC | $118 |
| HAP | Medicare Advantage HMO/PPO-Physician-NONFAC | $118 |
| HAP | HAP Dual Products-FAC | $118 |
| HAP | Medicare Advantage-FAC | $118 |
| HAP | HAP Dual Products-NONFAC | $118 |
| HAP | Medicare Advantage HMO/PPO-Physician-FAC | $118 |
| HAP | Medicare Advantage-NONFAC | $118 |
| Humana | Medicare Advantage-FAC | $118 |
| Humana | Medicare Advantage-NONFAC | $121 |
| Hap | HMO/Ahl-Fac | $154 |
| Hap | HMO/Ahl-Nonfac | $154 |
| Aetna | All Products-FAC | $158 |
| Aetna | All Products-NONFAC | $158 |
Inpatient
—cash price (self-pay)
$1,731list price
$869–$1,558range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United Healthcare | UHC Commercial | $1,276 |
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