Emergency visit, high (level 4) at Jacksonville Memorial Hospital. CPT 99284.
What Jacksonville Memorial Hospital publishes for this service, straight from its standard-charges file, last updated September 17, 2026.
Outpatient / ER
$1,717cash price (self-pay)
$1,811list price
$2.74–$4,828range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross Blue Shield | Blue Cross Community MMAI/Dual Eligible | $183 |
| Coventry | Coventry Advantra Medicare Advantage HMO | $196 |
| Health Alliance | Health Alliance Medicare Advantage | $196 |
| Humana | Humana/ChoiceCare Medicare Advantage PPO/HMO | $196 |
| Medicare | Medicare | $196 |
| United HealthCare | United HealthCare Medicare Advantage | $206 |
| Tricare | Tricare | $216 |
| WellCare Medicare Advantage PPO | WellCare Medicare Advantage PPO | $285 |
| UHC Va Ccn | UHC Va Ccn | $290 |
| Medicaid | Illinois Medicaid | $343 |
| Molina HealthCare | Molina Medicaid | $343 |
| Commercial Workers Compensation | Commercial Workers Compensation | $435 |
| Illinois Workers Compensation | Illinois Workers Compensation | $594 |
| Health Alliance MH Employee plan | Health Alliance MH Employee plan | $833 |
| Corvel/CorCare | Corvel/CorCare | $969 |
| 6 Degrees Health | 6 Degrees Health | $1,086 |
| Hope Trust | Hope Trust | $1,086 |
| Hst | Hst | $1,086 |
| Health Alliance | Health Alliance Fully Insured/Self Funded/ACA | $1,203 |
| Cigna | Cigna | $1,255 |
| Aetna | Aetna PPO | $1,352 |
| Current Health Network | Current Health Network | $1,358 |
| Healthlink | Healthlink HMO | $1,491 |
| Humana/ChoiceCare | Humana/ChoiceCare | $1,544 |
| PHCS/Multiplan | PHCS/Multiplan PPO | $1,629 |
| Hfn | Hfn PPO | $1,720 |
| HFN | HFN Workers Compensation | $1,720 |
| Blue Cross Blue Shield | BCBS PPO/HMO/Employee | $1,811 |
| Liability | Liability | $1,811 |
| United Healthcare | United Healthcare PPO | $3,099 |
Inpatient
$1,717cash price (self-pay)
$1,811list price
$790–$1,904range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Alliance MH Employee plan | Health Alliance MH Employee plan | $833 |
| Current Health Network | Current Health Network | $996 |
| 6 Degrees Health | 6 Degrees Health | $1,086 |
| Hope Trust | Hope Trust | $1,086 |
| Hst | Hst | $1,086 |
| Cigna | Cigna | $1,255 |
| Aetna | Aetna PPO | $1,266 |
| Humana/ChoiceCare | Humana/ChoiceCare | $1,544 |
| Hfn | Hfn PPO | $1,720 |
| HFN | HFN Workers Compensation | $1,720 |
| Blue Cross Blue Shield | BCBS PPO/HMO/Employee | $1,811 |
| Liability | Liability | $1,811 |
Billed more than this?
Scan my billSnap a photo of your bill. We compare every line with these prices and coding rules, free.