Emergency visit, high (level 4) at Froedtert Community Hospital - Pewaukee. CPT 99284.
What Froedtert Community Hospital - Pewaukee publishes for this service, straight from its standard-charges file, last updated December 31, 2025.
Outpatient / ER
$673cash price (self-pay)
$1,223list price
$413–$3,798range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem Blue Cross Blue Shield | Medicare Advantage | $413 |
| Care Wisconsin | Medicare Advantage | $413 |
| Community Care | Medicare Advantage | $413 |
| Health Partners | Medicare Advantage | $413 |
| Humana | Medicare Advantage | $413 |
| ICare | Medicare Advantage | $413 |
| Molina | Medicare Advantage | $413 |
| Network Health Plan | Medicare Advantage | $413 |
| Security Health Plan Secure Savers | Medicare Advantage | $413 |
| United Healthcare | Medicare Advantage | $413 |
| Chorus Community Health Plan | All Contracted Commercial Plans | $489 |
| Medical College of Wisconsin | Employee Plan | $489 |
| Centivo | WI 2 Median | $514 |
| Centivo | WI 1 Broad | $587 |
| Cigna | All Contracted Commercial Plans | $718 |
| Common Ground | All Contracted Commercial Plans | $734 |
| Sheboygan Employers Health Network | All Contracted Commercial Payers | $734 |
| Wisconsin Physician Services | All Contracted Commercial Plans | $734 |
| Health Payment Systems | All Contracted Commercial Plans | $747 |
| Health Partners | All Contracted Commercial Payers | $795 |
| Trilogy | All Contracted Commercial Plans | $795 |
| Americas Choice | PPO | $1,064 |
| HealthEos | All Contracted Commercial Plans | $1,064 |
| Multiplan/Private Healthcare Systems | All Contracted Commercial Plans | $1,064 |
| First Health Network | All Contracted Commercial Plans | $1,076 |
| Network Health Plan | ACA | $2,066 |
| Network Health Plan | All Contracted Commercial Payers | $2,296 |
| United Healthcare | Nexus | $2,311 |
| United Healthcare | Choice Plus/Navigate | $2,716 |
| Anthem Blue Cross Blue Shield | Blue Preferred/HMO/POS | $2,954 |
Inpatient
$673cash price (self-pay)
$1,223list price
$734–$1,414range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Common Ground | All Contracted Commercial Plans | $734 |
| Health Payment Systems | All Contracted Commercial Plans | $747 |
| Trilogy | All Contracted Commercial Plans | $795 |
| Americas Choice | PPO | $1,064 |
| HealthEos | All Contracted Commercial Plans | $1,064 |
| Multiplan/Private Healthcare Systems | All Contracted Commercial Plans | $1,064 |
| First Health Network | All Contracted Commercial Plans | $1,076 |
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All common services at Froedtert Community Hospital - Pewaukee