Emergency visit, high (level 4) at Lake Granbury Medical Center. CPT 99284.
What Lake Granbury Medical Center publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$945cash price (self-pay)
$5,248list price
$115–$4,986range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | NODE Wellpoint CHIP Medicaid TX | $250 |
| NODE Tricare | NODE Tricare | $398 |
| NODE ChampVA | NODE ChampVA | $419 |
| NODE Aetna CHIP Medicaid TX | NODE Aetna CHIP Medicaid TX | $714 |
| NODE Cook Childrens Health Plan CHIP Medicaid TX | NODE Cook Childrens | $714 |
| Medicaid | NODE TX Medicaid | $714 |
| NON PAR TX Medicaid | NODE TX Medicaid NON PAR | $714 |
| NODE UHC CHIP/STAR KIDS Medicaid TX | NODE UHC CHIP Medicaid TX | $714 |
| NODE UHC STAR KIDS Medicaid TX | NODE UHC STAR KIDS Medicaid TX | $714 |
| NODE UHC STAR Medicaid TX | NODE UHC STAR Medicaid TX | $714 |
| Healthspring | NODE Cigna Healthspring Medicaid TX | $749 |
| NODE Molina CHIP Medicaid TX | NODE Molina CHIP Medicaid TX | $749 |
| NODE Molina Medicaid TX | NODE Molina STAR Medicaid TX | $749 |
| NODE Superior CHIP/STAR KIDS/ STAR HEALTH Medicaid TX | NODE Superior | $821 |
| NODE Superior STAR KIDS Medicaid TX | NODE Superior STAR KIDS Medicaid | $821 |
| Superior | NODE Superior STAR Medicaid TX | $821 |
| NODE Superior STAR PLUS Medicaid TX | NODE Superior STAR PLUS Medicaid | $821 |
| NODE Aetna STAR KIDS Medicaid TX | NODE Aetna STAR KIDS Medicaid TX | $971 |
| NODE Cook Childrens Health Plan STAR KIDS Medicaid TX | NODE Cook Chil | $971 |
| BCBS TX | BCBS TX Blue ADV | $1,226 |
| BCBS TX | BCBS TX HMO | $1,291 |
| BCBS TX | BCBS TX PPO Trad | $1,291 |
| CHS Group Health Plan BCBST | CHS Group Health Plan BCBST | $1,323 |
| Cigna | Cigna New Business | $1,333 |
| Cigna | Cigna ALL | $2,068 |
| United Healthcare | NODE UHC STAR PLUS Medicaid TX | $2,213 |
| NODE Molina STAR PLUS Medicaid TX | NODE Molina STAR PLUS Medicaid TX | $2,323 |
| Aetna | Aetna Whole Health | $2,388 |
| Aetna | Aetna NBD | $2,519 |
| Aetna | NODE Aetna STAR Medicaid TX | $2,569 |
Inpatient
$1,417cash price (self-pay)
$5,248list price
$577–$4,986range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Self Pay | Self Pay | $577 |
| CHS Group Health Plan BCBST | CHS Group Health Plan BCBST | $1,323 |
| Cigna | Cigna New Business | $1,333 |
| United Healthcare | UHC APA | $2,231 |
| Aetna | Aetna Whole Health | $2,388 |
| Aetna | Aetna NBD | $2,519 |
| Aetna | Aetna PPO HMO | $2,808 |
| Healthsmart | Healthsmart ACCEL | $2,886 |
| Aetna | Aetna NAB First Health Rental | $2,986 |
| Aetna | Aetna Auto | $3,605 |
| Healthsmart | Healthsmart PPO HPO | $3,674 |
| Santa Fe Hospital Association | Santa Fe Hospital Association | $4,198 |
| Multiplan | Multiplan Complementary | $4,618 |
| Galaxy Health | Galaxy Health PPO | $4,986 |
| MedCorp Southwest | MedCorp Southwest | $4,986 |
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