Emergency visit, high (level 4) at Ira Davenport Memorial Hospital. CPT 99284.
What Ira Davenport Memorial Hospital publishes for this service, straight from its standard-charges file, last updated March 27, 2026.
Outpatient / ER
$229cash price (self-pay)
$1,143list price
$91.22–$1,143range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Empire | All Products Non MD | $91.22 |
| Empire | All Products MD | $108 |
| Excellus BCBS | Managed Medicaid | $333 |
| FIDELIS | Managed Medicaid_Aliessa and CHP | $333 |
| FIDELIS | Essential Plan QHP | $400 |
| Excellus BCBS | Medicare Advantage | $448 |
| FIDELIS | Health Benefit Exchange | $448 |
| Excellus BCBS | All Products | $478 |
| Aetna | All Products | $971 |
| EMBLEM/GHI | All Products | $1,005 |
| UHC | All Products | $1,143 |
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