Emergency visit, high (level 4) at Saint Marys Hospital. CPT 99284.
What Saint Marys Hospital publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$40.48cash price (self-pay)
$253list price
$12.06–$3,100range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Connecticare Vip Medicare Advantage | Connecticare Medicare Advantage | $490 |
| Aetna Medicare Advantage | Aetna Medicare Advantage | $490 |
| Blue Cross - Ct (Anthem) Medicare Advantage | Anthem Mediblue Medicare | $490 |
| Medigold Medicare Advantage | Mount Carmel Health Plan Medicare Adv | $490 |
| United Healthcare Medicare | United Healthcare Medicare Advantage | $490 |
| Health New England Medicare Advantage | Health New England Medicare Ad | $495 |
| 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 |
| Centivo | Centivo | $1,000 |
| Innovative Health Plan II | Innovative Health Plan | $1,050 |
| Claimdoc | Claimdoc | $1,050 |
| Health New England | Health New England | $1,083 |
| Blue Cross - Ut (Regence) | Anthem | $1,484 |
| Blue Cross - Vt | Anthem | $1,484 |
| Blue Cross - TX | Anthem | $1,484 |
| Blue Cross - Wv (Highmark) | Anthem | $1,484 |
| Blue Cross - Wy | Anthem | $1,484 |
| Blue Benefit Administrators Of Massachusetts | Anthem | $1,484 |
| Blue Distinction Transplant | Anthem | $1,484 |
| Blue Cross Domestic | Anthem | $1,484 |
| Bcn Domestic | Anthem | $1,484 |
| Blue Cross - Va (Carefirst) | Anthem | $1,484 |
| Blue Cross - Wa (Premera) | Anthem | $1,484 |
| Blue Shield - Wa (Regence) | Anthem | $1,484 |
| Blue Care Network | Anthem | $1,484 |
| Blue Cross - La | Anthem | $1,484 |
| Blue Cross - Me (Anthem) | Anthem | $1,484 |
Inpatient
$384cash price (self-pay)
$384list price
$66.77–$384range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Rx Meridian Rx | Medicaid | $66.77 |
| Tenncare | Medicaid | $66.77 |
| Caresource Medicaid | Medicaid | $66.77 |
| Blue Cross - Tn Medicaid Advantage | Medicaid | $66.77 |
| Molina Centennial Care | Medicaid | $66.77 |
| Molina Medicare Advantage | Medicare | $121 |
| Rx Allwin | Medicare | $121 |
| Ucare Medicare | Medicare | $121 |
| Network Medicare Advantage | Medicare | $121 |
| Care Dimensions | Medicare | $121 |
| Blue Cross - MA Medicare Advantage | Medicare | $121 |
| Champion Health Plan Mcr Advantage | Medicare | $121 |
| Blue Cross - Ms Medicare Advantage | Medicare | $121 |
| Blue Cross - Tn Medicare Advantage | Medicare | $121 |
| Medipak Advantage | Medicare | $121 |
| Blue Cross - FL Medicare Advantage | Medicare | $121 |
| Blue Cross - Ia (Wellmark) Medicare Advantage | Medicare | $121 |
| Rx Grane Grnmedd | Medicare | $121 |
| Blue Cross - Ct (Anthem) Medicare Advantage | Anthem BCBS Medicare Adv | $121 |
| Gold Advantage | Medicare | $121 |
| Healthfirst Medicare Advantage | Medicare | $121 |
| Health Partners Medicare Advantage | Medicare | $121 |
| Blue Cross - Wv (Highmark) Medicare Advantage | Medicare | $121 |
| Healthnet Medicare Advantage | Medicare | $121 |
| Eon Health Medicare Advantage | Medicare | $121 |
| Selecthealth Medicare Advantage | Medicare | $121 |
| Illinicare Health Medicare Advantage | Medicare | $121 |
| Wellcare Medicare | Wellcare Medicare Advantage | $124 |
| United Healthcare Medicare | UHC Medicare Advantage | $124 |
| Molina Medicare Advantage | Senior Whole Health Medicare Advantage | $130 |
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