Emergency visit, high (level 4) at lutheran hospital. CPT 99284.
What lutheran hospital publishes for this service, straight from its standard-charges file, last updated June 15, 2026.
Outpatient / ER
$1,910cash price (self-pay)
$2,938list price
$53.61–$2,644range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| ANTHEM | Managed Medicaid | $59.25 |
| Buckeye | Managed Medicaid | $59.25 |
| MOLINA | Managed Medicaid | $59.25 |
| CARESOURCE | Managed Medicaid | $60.38 |
| AMERIHEALTH | Managed Medicaid | $62.07 |
| Anthem | PPO/HMO | $255 |
| HUMANA | Medicare Advantage HMO | $395 |
| MMO | Medicare Advantage HMO | $395 |
| OPTUM | All Products VA | $395 |
| Aetna | Medicare Advantage | $395 |
| Anthem | Medicare Advantage | $395 |
| Devoted Health | Medicare Advantage | $395 |
| MMO | Medicare Advantage PPO | $407 |
| Cigna | Medicare Advantage | $407 |
| CommuniCare | MEDICARE ADVANTAGE | $415 |
| Cc Ehp | All Products | $430 |
| AETNA | Acop | $1,145 |
| Mmo | All Products | $1,162 |
| Aultcare | PPO/HMO | $1,216 |
| Amish Community Aid Plan | ALL PRODUCTS | $1,322 |
| AETNA | Asa_Whirlpool_Peia | $1,336 |
| Cigna | All Products | $1,400 |
| Ohcp | All Products | $1,428 |
| Omas | All Products | $1,469 |
| AETNA | International | $1,515 |
| Mmo | Traditional | $1,537 |
| Mmo | Nasco | $1,537 |
| Ohio Healthy | TRANSPLANT | $1,587 |
| Healthsmart | All Products | $1,616 |
| Anthem | Traditional | $1,647 |
Inpatient
$1,910cash price (self-pay)
$2,938list price
$831–$2,644range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Oscar | All Products | $1,060 |
| Amish Community Aid Plan | ALL PRODUCTS | $1,469 |
| Anthem | Traditional | $1,699 |
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