Emergency visit, high (level 4) at Methodist Southlake Medical Center. CPT 99284.
What Methodist Southlake Medical Center publishes for this service, straight from its standard-charges file, last updated March 23, 2026.
Outpatient / ER
$775cash price (self-pay)
$2,582list price
$407–$6,160range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Champva [1000] | Mhs Hb Tricare Msmc | $407 |
| Tricare [1001] | Mhs Hb Tricare Msmc | $407 |
| Ust Health Proof [1005] | Mhs Hb UHC Medicare Complete Msmc | $420 |
| United Healthcare Medicare Managed Care [3044] | Mhs Hb UHC Medicare C | $420 |
| Globalhealth [1003] | Mhs Hb Global Health Msmc | $441 |
| Humana Commercial [2051] | Mhs Hb Humana Medicare Msmc | $445 |
| United Healthcare Managed Care [3021] | Mhs Hb UHC Exchange Msmc | $449 |
| Oscar Insurance Company [2057] | Mhs Hb Oscar HMO Msmc | $546 |
| Bright Healthcare [2222] | Mhs Hb Bright Health Msmc | $588 |
| Molina [3017] | Mhs Hb Molina Marketplace Msmc | $609 |
| Aetna [3000] | Mhs Hb Aetna Exchange Msmc | $680 |
| Aetna [3000] | Mhs Hb Aetna Cvs Msmc | $680 |
| Allied National [2031] | Mhs Hb 90 Degree Msmc | $693 |
| Entrust/90 Degree [2058] | Mhs Hb 90 Degree Msmc | $693 |
| Friday Health Plan [2061] | Mhs Hb Friday Health Msmc | $714 |
| Cigna [3004] | Mhs Hb Custom Ink Msmc | $777 |
| Evry Health [1013] | Mhs Hb Evry Msmc | $840 |
| Healthscope Benefits [2052] | Mhs Hb Dart Member Care Msmc | $1,134 |
| Dart Member Care [3039] | Mhs Hb Dart Member Care Msmc | $1,134 |
| Bind Benefits Inc [1004] | Mhs Hb United Healthcare Msmc | $1,407 |
| United Healthcare-Commercial [2026] | Mhs Hb United Healthcare Msmc | $1,407 |
| Freedom Life Insurance Company [2029] | Mhs Hb United Healthcare Msmc | $1,407 |
| United Healthcare-Managed Care [2067] | Mhs Hb United Healthcare Msmc | $1,407 |
| Definity Health [3006] | Mhs Hb United Healthcare Msmc | $1,407 |
| United Healthcare Managed Care [3021] | Mhs Hb United Healthcare Msmc | $1,407 |
| Aetna [3000] | Mhs Hb Aetna Baylor Scott And White Msmc | $1,446 |
| BCBS [3001] | Mhs Hb BCBS My Blue Health Msmc | $3,100 |
| Aetna Commercial [2042] | Mhs Hb Aetna TX Pref Plus II Msmc | $3,328 |
| Aetna Managed Care [2068] | Mhs Hb Aetna TX Pref Plus II Msmc | $3,328 |
| Aetna Commercial [2042] | Mhs Hb Aetna Texas Advantage Msmc | $3,523 |
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