Emergency visit, high (level 4) at Jefferson Memorial Hospital. CPT 99284.
What Jefferson Memorial Hospital publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$566cash price (self-pay)
$2,555list price
$110–$2,805range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Veterans Eval Services | Veterans Eval Services | $110 |
| BlueCare | BCBS TN TennCare Select | $115 |
| BlueCare | BCBS TN CoverKids | $125 |
| BlueCare | BCBS TN BlueCare | $171 |
| NODE Tricare | NODE Tricare | $360 |
| Humana | NODE Humana MCR ADV | $373 |
| NODE Medicare Non Par | NODE Medicare Non Par | $373 |
| NODE Medicare Traditional | NODE Medicare Traditional | $373 |
| Node UHC Mcr Adv | Node UHC Mcr Adv | $373 |
| NODE ChampVA | NODE ChampVA | $379 |
| NODE BlueCare Plus TN MCR ADV | NODE BlueCare Plus TN MCR ADV | $379 |
| NODE Hospice Non Par Agree | NODE Hospice Non Par | $379 |
| NODE United Optum VA CCN | NODE United Optum VA CCN | $379 |
| Node Va | Node Va | $379 |
| NODE Devoted Health MCR ADV | NODE Devoted Health MCR ADV | $380 |
| NODE Farm Bureau MCR ADV | NODE Farm Bureau MCR ADV | $380 |
| NODE Aetna MCR ADV | NODE Aetna MCR ADV | $384 |
| Node BCBS Mcr Adv | Node BCBS Mcr Adv | $384 |
| NODE Healthspring MCR ADV | NODE Healthspring MCR ADV | $384 |
| NODE Amerigroup MCR ADV | NODE Amerigroup MCR ADV | $391 |
| United Healthcare | NODE UHC MCR Dual ADV | $391 |
| NODE Wellcare MCR ADV | NODE Wellcare MCR ADV | $394 |
| Node Nhc Mcr Adv | Node Nhc Mcr Adv | $410 |
| Amerigroup | Amerigroup Community Care | $415 |
| NODE US Dept of Labor | NODE US Dept of Labor | $473 |
| CHS Group Health Plan BCBST | CHS Group Health Plan BCBST | $519 |
| Self Pay | Self Pay | $566 |
| NovaNet Work Comp TN | NovaNet Work Comp TN | $632 |
| Occunet Work Comp TN | Occunet Work Comp TN | $639 |
| NODE Ambetter Health Exchange | NODE Ambetter Health Exchange | $700 |
Inpatient
$566cash price (self-pay)
$2,555list price
$519–$2,555range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| CHS Group Health Plan BCBST | CHS Group Health Plan BCBST | $519 |
| Multiplan Complementary | Multiplan Complementary | $2,019 |
| United Healthcare | UHC APA | $2,555 |
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