Emergency visit, high (level 4) at Ascension Seton Edgar B. Davis (Ascension Seton). CPT 99284.
What Ascension Seton Edgar B. Davis (Ascension Seton) publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$1,120cash price (self-pay)
$3,112list price
$200–$3,360range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Superior Star | 3509_chirp Superior Star (Chi,Dcn) Inpatient 20240901 | $200 |
| Superior Star | 3511_chirp Superior Star (Ebd) Inpatient 20240901 | $200 |
| Superior Star Plus | 4375_chirp Superior Star Plus (Chi,Dcn) Inpatient | $200 |
| Superior Star Plus | 4377_chirp Superior Star Plus (Ebd) Inpatient 202 | $200 |
| BCBS Star | 4221_chirp Blue Cross Star (Ebd) Outpatient 20241201 | $311 |
| Tricare | 1229_tricare Cah Outpatient 20170101 | $316 |
| Superior Ambetter | 3879_superior Ambetter (Chi,Dcn) Inpatient 2024090 | $348 |
| Superior Ambetter | 3880_superior Ambetter (Chi,Dcn) Outpatient 202409 | $348 |
| BCBS Chip/Chip Perinate | 4170_blue Cross Chip (Ebd) Outpatient 202412 | $405 |
| BCBS Chip/Chip Perinate | 4170_blue Cross Chip/Star Kids (Ebd) Outpati | $405 |
| BCBS Star Kids | 5007_blue Cross Star Kids (Ebd) Outpatient 20241201 | $405 |
| Dell Chip/Chip Perinate | 4181_dell Chip/Star Kids (Ebd) Outpatient 20 | $405 |
| BCBS Chip/Chip Perinate | 3594_blue Cross Chip/Star Kids (Chi,Dcn) Inp | $450 |
| BCBS Chip/Chip Perinate | 4168_blue Cross Chip (Chi,Dcn) Outpatient 20 | $450 |
| BCBS Chip/Chip Perinate | 4168_blue Cross Chip/Star Kids (Chi,Dcn) Out | $450 |
| BCBS Star | 3693_chirp Blue Cross Star (Chi,Dcn) Inpatient 20240901 | $450 |
| BCBS Star Kids | 5003_blue Cross Star Kids (Chi,Dcn) Outpatient 202412 | $450 |
| BCBS Chip/Chip Perinate | 3596_blue Cross Chip/Star Kids (Ebd) Inpatie | $498 |
| BCBS Star | 3695_chirp Blue Cross Star (Ebd) Inpatient 20240901 | $498 |
| Dell Chip/Chip Perinate | 3607_dell Chip/Star Kids (Ebd) Inpatient 202 | $498 |
| Humana HMO | 2668_humana HMO 20230701 | $1,106 |
| Whole Foods | 4512_whole Foods 20251001 | $1,140 |
| Seton Performance Plus | 785_seton Performance EPO PPO (Aus,Nw,Sw,Hay) | $1,276 |
| Seton Performance Plus | 788_seton Performance EPO PPO (Wil,Del,Brk,Ba | $1,276 |
| Aetna Choice | 236_aetna Elect Choice 20140601 | $1,325 |
| Aetna POS 20140601 | 235_aetna POS 20140601 | $1,325 |
| Aetna Sha Aisd | 4335_aetna Sha Aisd 20250101 | $1,368 |
| Oscar Health Exchange | 4511_oscar Health Plan 20251001 | $1,381 |
| Cigna HMO | 4475_cigna HMO (Aus,Nw,Sw,Hay) 20250701 | $1,400 |
| Cigna HMO | 4476_cigna HMO (Wil,Del) 20250701 | $1,400 |
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All common services at Ascension Seton Edgar B. Davis (Ascension Seton)