Emergency visit, high (level 4) at Johnson Memorial Hospital. CPT 99284.
What Johnson Memorial Hospital publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$40.48cash price (self-pay)
$1,862list price
$12.06–$6,550range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Molina Medicare Advantage | Medicare | $70.30 |
| Rx Allwin | Medicare | $70.30 |
| Connecticare Vip Medicare Advantage | Connecticare Medicare Advantage | $490 |
| Aetna Medicare Advantage | Aetna Medicare Advantage | $490 |
| United Healthcare Medicare | United Healthcare Medicare Advantage | $490 |
| Health New England Medicare Advantage | Health New England Medicare Ad | $495 |
| Fallon Health Medicare Advantage | Fallon Medicare Advantage | $500 |
| Carepartners Of Connecticut Medicare Advantage | Carepartners Medicare | $500 |
| Cca Senior Care Options | Commonwealth Care Alliance Medicare Adv | $500 |
| Wellcare Medicare | Wellcare Medicare Advantage | $500 |
| Cigna Medicare Advantage | Cigna Medicare Advantage | $505 |
| Prime Health Services Medicare Advantage | Prime Health Medicare Advan | $510 |
| Fallon Health Medicare Advantage | Fallon Navicare Medicare Advantage | $515 |
| Health New England | Health New England | $724 |
| Connecticare | Connecticare Cbi | $828 |
| Multiplan | Multiplan | $876 |
| Innovative Health Plan II | Innovative Health Plan | $1,050 |
| Claimdoc | Claimdoc | $1,050 |
| Centivo | Centivo | $1,166 |
| Blue Cross - Ct (Anthem) | Anthem Individual Pathway HMO PPO | $1,672 |
| Blue Cross - CA (Anthem) | Anthem | $2,158 |
| Blue Cross - Ky (Anthem) | Anthem | $2,158 |
| Blue Cross - Dc (Carefirst) | Anthem | $2,158 |
| Blue Cross - FL | Anthem | $2,158 |
| Blue Cross - Ga (Anthem) | Anthem | $2,158 |
| Blue Cross - Hi | Anthem | $2,158 |
| Blue Cross - Ct (Anthem) | Anthem | $2,158 |
| Blue Cross - Wy | Anthem | $2,158 |
| Blue Cross - Wv (Highmark) | Anthem | $2,158 |
| Blue Benefit Administrators Of Massachusetts | Anthem | $2,158 |
Inpatient
$40.48cash price (self-pay)
$212list price
$12.06–$384range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Maryland Healthy Smiles - Scion Dental | Medicaid | $36.72 |
| Idaho Womens Health Check | Medicaid | $36.72 |
| Indiana Breast Cervical Cancer | Medicaid | $36.72 |
| Community Care Partners | Medicaid | $36.72 |
| Cmh Lenawee County | Medicaid | $36.72 |
| Cmh Livingston County | Medicaid | $36.72 |
| Hap Medicaid | Medicaid | $36.72 |
| Affinity Health Plan Medicaid Advantage | Medicaid | $36.72 |
| Dscc | Medicaid | $36.72 |
| Rx Allwin | Medicare | $61.21 |
| Molina Medicare Advantage | Medicare | $61.21 |
| Central Health Medicare Advantage | Medicare | $61.21 |
| Blue Cross - Mt Medicare Advantage | Medicare | $61.21 |
| Blue Shield - CA Medicare Advantage | Medicare | $61.21 |
| Blue Cross - Ok Medicare Advantage | Medicare | $61.21 |
| Blue Shield - Id (Regence) Medicare Advantage | Medicare | $61.21 |
| Blue Shield - NY Highmark Northeastern Medicare Advantage | Medicare | $61.21 |
| Preferred Care Partners | Medicare | $61.21 |
| Icare Medicare Advantage | Medicare | $61.21 |
| Security Health Medicare | Medicare | $61.21 |
| Network Medicare Advantage | Medicare | $61.21 |
| Osu Prime Care Advantage | Medicare | $61.21 |
| Wellcare Medicare | Wellcare Medicare Advantage | $62.46 |
| United Healthcare Medicare | UHC Medicare Advantage | $62.46 |
| Wc Secura | Workers Comp | $102 |
| Wc City Of Albany | Workers Comp | $102 |
| Andrie Inc | Workers Comp | $102 |
| Wc Aetna | Workers Comp | $102 |
| Wc Occ Health Allen | Workers Comp | $102 |
| Wc Liberty Mutual | Workers Comp | $102 |
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