Emergency visit, high (level 4) at Ascension Seton Smithville (Ascension Seton). CPT 99284.
What Ascension Seton Smithville (Ascension Seton) publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$883cash price (self-pay)
$3,006list price
$200–$3,360range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Superior Star | 3509_chirp Superior Star (Chi,Dcn) Inpatient 20240901 | $200 |
| Superior Star | 3515_chirp Superior Star (Smv) Inpatient 20240901 | $200 |
| Superior Star | 4247_chirp Superior Star (Smv) Outpatient 20241201 | $200 |
| Superior Star Plus | 4375_chirp Superior Star Plus (Chi,Dcn) Inpatient | $200 |
| Superior Star Plus | 4381_chirp Superior Star Plus (Smv) Inpatient 202 | $200 |
| Superior Star Plus | 4401_chirp Superior Star Plus (Smv) Outpatient 20 | $200 |
| BCBS Chip/Chip Perinate | 4174_blue Cross Chip (Smv) Outpatient 202412 | $263 |
| BCBS Chip/Chip Perinate | 4174_blue Cross Chip/Star Kids (Smv) Outpati | $263 |
| BCBS Star | 4225_chirp Blue Cross Star (Smv) Outpatient 20241201 | $263 |
| BCBS Star Kids | 5015_blue Cross Star Kids (Smv) Outpatient 20241201 | $263 |
| Tricare | 1229_tricare Cah Outpatient 20170101 | $316 |
| BCBS Chip/Chip Perinate | 3600_blue Cross Chip/Star Kids (Smv) Inpatie | $329 |
| BCBS Star | 3699_chirp Blue Cross Star (Smv) Inpatient 20240901 | $329 |
| 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 | $440 |
| BCBS Chip/Chip Perinate | 4168_blue Cross Chip (Chi,Dcn) Outpatient 20 | $440 |
| BCBS Chip/Chip Perinate | 4168_blue Cross Chip/Star Kids (Chi,Dcn) Out | $440 |
| BCBS Star | 3693_chirp Blue Cross Star (Chi,Dcn) Inpatient 20240901 | $440 |
| BCBS Star Kids | 5003_blue Cross Star Kids (Chi,Dcn) Outpatient 202412 | $440 |
| 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) | $1,250 |
| Seton Performance Plus | 788_seton Performance EPO PPO (Wil,Del,Brk,Ba | $1,250 |
| 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 |
| Cigna HMO | 4475_cigna HMO (Aus,Nw,Sw,Hay) 20250701 | $1,372 |
| Cigna HMO | 4476_cigna HMO (Wil,Del) 20250701 | $1,372 |
| Oscar Health Exchange | 4511_oscar Health Plan 20251001 | $1,381 |
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All common services at Ascension Seton Smithville (Ascension Seton)