Emergency visit, high (level 4) at Ascension Seton Northwest (Ascension Seton). CPT 99284.
What Ascension Seton Northwest (Ascension Seton) publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$1,082cash price (self-pay)
$3,006list price
$173–$3,360range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS Chip/Chip Perinate | 3598_blue Cross Chip/Star Kids (Nw) Inpatien | $187 |
| BCBS Chip/Chip Perinate | 4172_blue Cross Chip (Nw) Outpatient 2024120 | $187 |
| BCBS Chip/Chip Perinate | 4172_blue Cross Chip/Star Kids (Nw) Outpatie | $187 |
| BCBS Star | 3697_chirp Blue Cross Star (Nw) Inpatient 20240901 | $187 |
| BCBS Star Kids | 5011_blue Cross Star Kids (Nw) Outpatient 20241201 | $187 |
| BCBS Star | 4223_chirp Blue Cross Star (Nw) Outpatient 20241201 | $187 |
| Superior Star | 3509_chirp Superior Star (Chi,Dcn) Inpatient 20240901 | $200 |
| Superior Star | 3513_chirp Superior Star (Nw) Inpatient 20240901 | $200 |
| Superior Star | 4245_chirp Superior Star (Nw) Outpatient 20241201 | $200 |
| Superior Star Plus | 4375_chirp Superior Star Plus (Chi,Dcn) Inpatient | $200 |
| Superior Star Plus | 4379_chirp Superior Star Plus (Nw) Inpatient 2024 | $200 |
| Superior Star Plus | 4397_chirp Superior Star Plus (Nw) Outpatient 202 | $200 |
| 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 | 3594_blue Cross Chip/Star Kids (Chi,Dcn) Inp | $470 |
| BCBS Chip/Chip Perinate | 4168_blue Cross Chip (Chi,Dcn) Outpatient 20 | $470 |
| BCBS Chip/Chip Perinate | 4168_blue Cross Chip/Star Kids (Chi,Dcn) Out | $470 |
| BCBS Star | 3693_chirp Blue Cross Star (Chi,Dcn) Inpatient 20240901 | $470 |
| BCBS Star Kids | 5003_blue Cross Star Kids (Chi,Dcn) Outpatient 202412 | $470 |
| Humana HMO | 2668_humana HMO 20230701 | $1,106 |
| Whole Foods | 4512_whole Foods 20251001 | $1,140 |
| Aetna Choice | 236_aetna Elect Choice 20140601 | $1,325 |
| Aetna POS 20140601 | 235_aetna POS 20140601 | $1,325 |
| Seton Performance Plus | 785_seton Performance EPO PPO (Aus,Nw,Sw,Hay) | $1,333 |
| Seton Performance Plus | 788_seton Performance EPO PPO (Wil,Del,Brk,Ba | $1,333 |
| Aetna Sha Aisd | 4335_aetna Sha Aisd 20250101 | $1,368 |
| Oscar Health Exchange | 4511_oscar Health Plan 20251001 | $1,381 |
| BCBS PPO | 4094_blue Cross Blue Shield PPO 20250101 | $1,460 |
| Cigna HMO | 4475_cigna HMO (Aus,Nw,Sw,Hay) 20250701 | $1,463 |
Inpatient
—cash price (self-pay)
—list price
$404–$743range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aarp Mc Wellmed | 4656_medicare Advantage Aarp Wellmed Inpatient (Aus, | $404 |
| Sendero Chap | 4651_sendero Chap Inpatient 20251001 | $409 |
| Addr Cancer Together | 4681_addr Cancer Together Inpatient 20251001 | $413 |
| Aetna Mcr Replacement | 4659_medicare Advantage Aetna Inpatient 202510 | $413 |
| Ascension Complete Medicare Replacement | 4682_medicare Advantage Asce | $413 |
| Covid Hrsa | 4693_covid Hrsa Unin Q80 Inpatient 20251001 | $413 |
| Cshcn Cidc | 4694_cshcn Cidc Ip (Adult) 20251001 | $413 |
| Devoted Health Mcr Replacement | 4684_medicare Advantage Devoted Healt | $413 |
| Humana Mcr Replacement | 4661_medicare Advantage Humana Inpatient (Aus | $413 |
| Medicare Oon | 4666_medicare Advantage Inpatient Oon 20251001 | $413 |
| Medicare Replacement | 4665_medicare Advantage Inpatient 100% 20251001 | $413 |
| Research Study | 4650_research Study Ip 20251001 | $413 |
| Smarthealth | 4680_smarthealth Ip 20251001 | $413 |
| Superior Allwell | 4686_medicare Advantage Superior Allwell Inpatient | $413 |
| Tricare | 4696_tricare Inpatient 20251001 | $413 |
| Wellcare Med Advantage | 4691_medicare Advantage Wellcare Inpatient 20 | $413 |
| Welmed Medicare | 4669_medicare Advantage Welmed Inpatient (Aus,Nw,Sw, | $413 |
| UHC Mcr Replacement | 4687_medicare Advantage United Healthcare Inpati | $421 |
| Connected Senior Care | 4660_medicare Advantage Connected Senior Care | $425 |
| Pphp Mcr Advantage | 4668_medicare Advantage Pphp Inpatient 20251001 | $433 |
| TX Independence Hp | 4671_tx Independence Hp Ip 20251001 | $433 |
| Occunet | 4674_occunet Ip 20251001 | $578 |
| Sendero Idealcare | 4675_sendero Idealcare Ip 20251001 | $722 |
| Superior Ambetter | 4652_superior Ambetter Inpatient 20251001 | $743 |
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All common services at Ascension Seton Northwest (Ascension Seton)