Emergency visit, high (level 4) at Froedtert Holy Family Memorial Hospital. CPT 99284.
What Froedtert Holy Family Memorial Hospital publishes for this service, straight from its standard-charges file, last updated December 31, 2025.
Outpatient / ER
$601cash price (self-pay)
$1,447list price
$361–$5,506range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem Blue Cross Blue Shield | Medicare Advantage | $405 |
| Community Care Incorporated | Medicare Advantage | $405 |
| Health Partners | Medicare Advantage | $405 |
| Humana | Medicare Advantage | $405 |
| ICare | Medicare Advantage | $405 |
| Molina | Medicare Advantage | $405 |
| Network Health Plan | Medicare Advantage | $405 |
| Security Health Plan | Medicare Advantage | $405 |
| United Healthcare | Medicare Advantage | $405 |
| Allwell | Medicare Advantage | $413 |
| Molina | Marketplace Plans | $437 |
| Medical College of Wisconsin | Employee Plan | $477 |
| Centivo | WI 2 Median | $608 |
| Centivo | WI 1 Broad | $694 |
| Dean Health Plan | All Plans | $723 |
| Health Payment Systems | All Contracted Commercial Plans | $816 |
| Sheboygan Employers Health Network | All Contracted Commercial Plans | $868 |
| Chorus Community Health Plan | Marketplace Plans | $930 |
| Health Partners | All Contracted Commercial Plans | $940 |
| Trilogy | All Contracted Commercial Plans | $955 |
| Cigna | All Contracted Commercial Plans | $1,041 |
| WPS Health Plan | All Contracted Commercial Plans | $1,070 |
| Aspirus | Marketplace Plans | $1,157 |
| HealthEos | All Contracted Commercial Plans | $1,157 |
| Multiplan/Private Healthcare Systems | All Contracted Commercial Plans | $1,157 |
| Preferred One | All Contracted Commercial Plans | $1,157 |
| Security Health Plan | All Contracted Commercial Plans | $1,157 |
| HealthSmart | All Contracted Commercial Plans | $1,201 |
| First Health Network | All Contracted Commercial Plans | $1,273 |
| Network Health Plan | ACA | $2,416 |
Inpatient
$601cash price (self-pay)
$1,447list price
$656–$1,584range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Sheboygan Employers Health Network | All Contracted Commercial Plans | $868 |
| Trilogy | All Contracted Commercial Plans | $955 |
| Cigna | All Contracted Commercial Plans | $1,041 |
| Aspirus | Marketplace Plans | $1,157 |
| HealthEos | All Contracted Commercial Plans | $1,157 |
| Multiplan/Private Healthcare Systems | All Contracted Commercial Plans | $1,157 |
| Preferred One | All Contracted Commercial Plans | $1,157 |
| Security Health Plan | All Contracted Commercial Plans | $1,157 |
| HealthSmart | All Contracted Commercial Plans | $1,201 |
| First Health Network | All Contracted Commercial Plans | $1,273 |
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All common services at Froedtert Holy Family Memorial Hospital