Emergency visit, high (level 4) at WTH Bolivar Hospital. CPT 99284.
What WTH Bolivar Hospital publishes for this service, straight from its standard-charges file, last updated June 2, 2026.
Outpatient / ER
$1,366cash price (self-pay)
$4,553list price
$661–$3,142range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Celtic Insurance Company | Commercial-Exchange | $661 |
| River Valley Plan | TennCare | $739 |
| Veterans Affairs | Community Care Network | $1,093 |
| Blue Cross Blue Shield of Tennessee | BlueCare | $1,126 |
| Blue Cross Blue Shield of Tennessee | BlueChoice HMO | $1,126 |
| Cigna-HealthSpring | Medicare Advantage | $1,134 |
| Oscar | HMO/Medicare Advantage/PPO/EPO/POS | $1,462 |
| Blue Cross Blue Shield of Tennessee | Network S/E | $1,658 |
| Blue Cross Blue Shield of Tennessee | Network P | $1,801 |
| United Healthcare | All Payer | $1,882 |
| Aetna | AWH/Vanderbilt Health Affiliated Network (VHAN)/VHAN - Employe | $1,976 |
| Aetna | Commercial | $3,142 |
Inpatient
$1,366cash price (self-pay)
$4,553list price
$3,142–$3,142range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | Commercial | $3,142 |
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