Emergency visit, high (level 4) at Baylor Scott & White Medical Center - Grapevine. CPT 99284.
What Baylor Scott & White Medical Center - Grapevine publishes for this service, straight from its standard-charges file, last updated June 29, 2026.
Outpatient / ER
$1,274cash price (self-pay)
$2,123list price
$318–$3,894range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Superior Health Plan | Medicaid | $318 |
| Aetna | Medicaid | $325 |
| United Healthcare | Medicaid/CHIP | $341 |
| Baylor Scott & White Health Plan | Medicare Advantage | $399 |
| CORVEL | Worker's Compensation | $407 |
| Aetna | Medicare Advantage | $420 |
| Humana | Medicare | $420 |
| TriWest | Community Care Network | $420 |
| American Health Plan | Medicare Advantage | $441 |
| Blue Cross Blue Shield | Medicare Advantage | $441 |
| HealthSpring | Medicare Advantage | $441 |
| ProCare Advantage | Medicare Advantage | $441 |
| Superior Health Plan | Medicare | $441 |
| United Healthcare | Medicare Advantage | $470 |
| Baylor Scott & White Health Plan | BSW Premier - Small Group | $504 |
| Baylor Scott & White Health Plan | BSW Premier - Individual | $527 |
| Prime Health Services | Worker's Compensation | $529 |
| Sedgwick | Preferred Network | $628 |
| Baylor Scott & White Health Plan | BSW Plus - Small Group | $693 |
| Superior Ambetter | Ambetter Exchange | $903 |
| Employers Health Network | BSWQA Direct/EHN Rental | $998 |
| Baylor Scott & White Health Plan | BSW Premier - Large Group/BSW Premi | $1,100 |
| QuikTrip | Employee Benefit Plan | $1,168 |
| Employers Health Network | EHN Network | $1,168 |
| Baylor Scott & White Health Plan | BSW Plus - Large Group/BSW Premier | $1,295 |
| University of Mary Hardin-Baylor | Commercial | $1,301 |
| Curative | Commercial | $1,380 |
| Blue Cross Blue Shield | Blue Advantage | $1,420 |
| First Health | PPO | $1,486 |
| Humana | Commercial PPO | $1,486 |
Inpatient
$1,274cash price (self-pay)
$2,123list price
$1,168–$1,486range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| QuikTrip | Employee Benefit Plan | $1,168 |
| Curative | Commercial | $1,380 |
| First Health | PPO | $1,486 |
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All common services at Baylor Scott & White Medical Center - Grapevine