Emergency visit, high (level 4) at Northwest Texas Healthcare System. CPT 99284.
What Northwest Texas Healthcare System publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
—cash price (self-pay)
$3,560list price
$95.47–$3,000range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Superior | Medicaid | $95.47 |
| Molina | Medicaid | $100 |
| First_care_chip | Medicaid | $105 |
| Wellpoint_starkids | Medicaid | $263 |
| Amerigroup | Medicaid | $289 |
| Oklahoma | Medicaid | $309 |
| First_care_star | Medicaid | $318 |
| Wellpoint_ Amgrp_star_plus | Medicaid | $341 |
| First_care_star_plus | Medicaid | $375 |
| Superior_star | Medicaid | $457 |
| Aetna | Managed_care | $712 |
| Superior_starkids | Medicaid | $756 |
| Superior_star_plus | Medicaid | $781 |
| Blue_cross_blue_shield_of_tx | Advantage | $2,040 |
| Cigna | Managed_care | $2,094 |
| Scott_and_white_healthplan | Managed_care | $2,142 |
| United_healthcare | Managed_care | $2,202 |
| Blue_cross_blue_shield_of_tx | HMO | $2,420 |
| Blue_cross_blue_shield_of_tx | PPO | $2,840 |
| Multiplan | Managed_care | $2,848 |
| Blue_cross_blue_shield_of_tx | Managed_care | $3,000 |
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