Emergency visit, high (level 4) at Ascension Saint Thomas Rutherford. CPT 99284.
What Ascension Saint Thomas Rutherford publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$945cash price (self-pay)
$3,150list price
$107–$4,291range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | 3161_rptn Aetna 20250701 | $107 |
| Aetna | 3162_rhtn Aetna 20250701 | $107 |
| Aetna | 3164_thtn Aetna 20250701 | $114 |
| BCBS Tenncare Select | 2414_bcbs Blue Care Tenncare (Rutherford) 20221 | $136 |
| Amerigroup Mcr Replacement | 2958_rptn Rhtn Thtn Sdtn Medicare Advanta | $326 |
| Amerigroup Mcr Replacement | 2959_sttn Mttn Medicare Advantage Amerigr | $326 |
| Ascension Complete | 2940_ascension Complete Medicare Advantage Outpat | $408 |
| Centurion Of Tn | 2942_medicare Advantage Centurion Of Tn Outpatient 2 | $408 |
| Clover Medicare Advantage | 2943_medicare Advantage Clover Outpatient | $408 |
| Healthspring Mcr Replacement | 2944_medicare Advantage Healthspring Ou | $408 |
| Humana Mcr Replacement | 2945_medicare Advantage Humana Outpatient 202 | $408 |
| Medicare Other | 2947_medicare Other Outpatient 20250101 | $408 |
| Nhc Advantage | 2948_mttn Rhtn Rptn Sdtn Sttn Medicare Advantage Nhc A | $408 |
| Optum Va | 2935_medicare Advantage Optum Va Outpatient 20250101 | $408 |
| Triwest Va Pccc | 1713_triwest Op (West, Rutherford) 20210101 | $408 |
| UHC Mcr Replacement | 2951_mttn Sttn Rptn Medicare Advantage UHC Outpa | $408 |
| Aetna Medadvantage | 2956_rhtn Rptn Sdtn Thtn Mttn Sttn Medicare Advan | $416 |
| BCBS Bluecare Plus | 2949_mttn Sttn Medicare Advantage Blue Cross Blue | $424 |
| BCBS Network E | 3149_blue Cross Blue Shield Network E Regional 202504 | $834 |
| BCBS Missionpoint | 2416_mttn Blue Cross Blue Shield Mission Point 202 | $851 |
| BCBS Missionpoint | 2422_blue Cross Blue Shield Missionpoint Regional | $851 |
| BCBS Network L | 3150_blue Cross Blue Shield Network L Regional 202504 | $906 |
| BCBS Select | 3182_blue Cross Blue Shield Select Regional 20250701 | $955 |
| BCBS Preferred | 3181_blue Cross Blue Shield Preferred Regional 202507 | $1,105 |
| BCBS Aca Exchange | 3147_sttn Blue Cross Blue Shield Network E 2024123 | $1,244 |
| BCBS Aca Exchange | 3146_mttn Blue Cross Blue Shield Network E 2024123 | $1,354 |
| BCBS Network L | 3151_mttn Blue Cross Blue Shield Network L 20250401 | $1,472 |
| BCBS Select | 3178_mttn Blue Cross Blue Shield Select 20250701 | $1,551 |
| Aetna (Rutherford Only) | 3160_mttn Aetna 20250701 | $1,638 |
| Aetna Vhan | 3022_mttn Aetna Vhan 20241015 | $1,670 |
Inpatient
—cash price (self-pay)
—list price
$367–$571range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Point Comfort Underwriters | 3224_mttn Rhtn Rptn Sdtn Sttn Medicare Ad | $367 |
| Americhoice Medicare | 3207_mttn, Sttn Americhoice Medicare Inpatient | $383 |
| Ascension Complete | 3229_ascension Complete Medicare Advantage Inpati | $408 |
| Centurion Of Tn | 3228_medicare Advantage Centurion Of Tn Inpatient 20 | $408 |
| Clover Medicare Advantage | 3227_medicare Advantage Clover Inpatient 2 | $408 |
| Covid Uninsured Test Fund | 3202_covid Uninsured Test Fund Inpatient 2 | $408 |
| Healthspring Mcr Replacement | 3219_mttn Sttn Rptn Sdtn Rhtn Medicare | $408 |
| Humana Mcr Replacement | 3222_mttn Sttn Medicare Advantage Humana Inpa | $408 |
| Medicare Other | 3204_mttn Sttn Medicare Other Inpatient 20251001 | $408 |
| Nhc Advantage | 3225_mttn Rhtn Rptn Sdtn Sttn Medicare Advantage Nhc A | $408 |
| Optum Va | 3205_medicare Advantage Optum Va Inpatient 20251001 | $408 |
| Triwest Va Pccc | 3235_mttn Sttn Triwest Inpatient 20251001 | $408 |
| UHC Mcr Replacement | 3226_medicare Advantage UHC Inpatient 20251001 | $408 |
| Aetna Medadvantage | 3214_rptn Rhtn Sdtn Thtn Mttn Sttn Medicare Advan | $416 |
| Amerigroup Mcr Replacement | 3210_sttn Mttn Medicare Advantage Amerigr | $420 |
| BCBS Bluecare Plus | 3223_mttn Sttn Medicare Advantage Blue Cross Blue | $424 |
| BCBS Mcr Replacement | 3238_thtn Medicare Advantage Blue Cross Blue Sh | $428 |
| Windsor Medicare | 3220_mttn Sttn Medicare Advantage Wellcare (Windsor | $428 |
| Ambetter Of Tn | 3236_ambetter Of Tn Inpatient 20251001 | $530 |
| Smart Health | 3237_mttn, Rptn, Rhtn, Sdtn, Thtn Ascension Smart Healt | $571 |
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