Emergency visit, high (level 4) at Medical City Lewisville Hospital. CPT 99284.
What Medical City Lewisville Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$3,315cash price (self-pay)
$3,315list price
$77.04–$5,296range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Molina | CHIP | $320 |
| Molina | MCDSTAR | $320 |
| Molina | STAR+PLUS | $320 |
| Molina | STARKIDS | $320 |
| Amerigroup | CHIP | $363 |
| Amerigroup | MGMCD | $363 |
| Cigna | IFP | $448 |
| Cigna | QHP | $464 |
| Cigna Healthspring | MGMCD | $700 |
| Healthcare Highways | CityofPlano | $1,121 |
| BCBS | Traditional | $1,373 |
| City of McKinney | COMM | $1,492 |
| United | NarrowNetworkIndivExchange | $1,545 |
| Aetna | ASA | $1,674 |
| Aetna | WCOMP | $1,823 |
| Aetna Coventry First Health | COMM | $1,900 |
| Averde Health, Inc | PPO | $1,923 |
| United | SmallGroup | $1,937 |
| Coastal Comp Health Networks | WCOMP | $2,321 |
| Jostens | WCOMP | $2,321 |
| Mega Life | MGMCRPPO | $2,321 |
| HealthSmart Preferred Care | PPO | $2,486 |
| Lewisville Isd/Dls Consulting | Commppo | $2,486 |
| BCBS | BlueAdvantageHMO | $2,740 |
| BCBS | MyBlueHealth | $2,740 |
| United | AllPayerAppendix | $2,931 |
| Independent Medical Systems | COMM | $3,315 |
| Healthcare Highways | NarrowNetwork | $3,542 |
| Evry Health | COMM | $3,626 |
| Cigna | LocalPlus | $3,746 |
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