Emergency visit, high (level 4) at Jones Memorial Hospital. CPT 99284.
What Jones Memorial Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$96.00cash price (self-pay)
$192list price
$40.54–$1,364range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Excellus Medicaid 1706, Excellus Blue Cross Blue Shield 2201 | Blue Ch | $43.07 |
| Mvp Medicaid 1712, Mvp 2900 | Mvp Option Medicaid 171201, Mvp Essentia | $91.27 |
| Excellus Medicaid 1706, Excellus Blue Cross Blue Shield 2201 | Univera | $94.31 |
| Capital District Physicians (Cdphp) Medicaid 1704 | Capital District P | $103 |
| Aetna Medicare 1300, Aetna 2700 | Aetna Medicare 130001, Aetna Senior | $105 |
| Excellus Blue Cross Blue Shield 2201 | Excellus Metal Tiers 220102, Un | $105 |
| Medicare Blue Choice 1306 | Medicare Blue Choice 130601, Blue Medicare | $105 |
| Medicare Blue Choice 1306 | Univera Senior Choice Medicare 130603 | $107 |
| Mvp 2900 | Mvp Premier Individual 290002, Mvp Premier Group 290003 | $112 |
| Mvp Medicare 1307, Mvp Medicare Dual Access Dsnp 1321 | Mvp Medicare 1 | $112 |
| Molina Medicaid 1723, Molina Healthcare 5189 | Molina Medicaid 172301, | $112 |
| Fidelis Medicaid 1708, Fidelis 5155 | Fidelis Medicaid 170801, Fidelis | $116 |
| Empire Plan 5179, Empire Plan UHC 5180 | Empire Plan 517901, Empire Pl | $118 |
| Fidelis Medicaid 1708, Fidelis 5155 | Fidelis Essential (W/ Medicaid) | $122 |
| Excellus Blue Cross Blue Shield 2201 | Univera 220104 | $135 |
| Lifetime Benefit Solutions 2200, Excellus Blue Cross Blue Shield 2201, | $147 |
| Mvp 2900, Cigna 5144 | Mvp Commercial Non PPO Fully Insured 290001, Mv | $154 |
| Fidelis 5155 | Fidelis Metal Tiers 515501 | $157 |
| Independent Health 5156 | Independent Health (Buffalo NY) 515601, Nova | $223 |
| Highmark Blue Cross Blue Shield Medicaid 1702 | Highmark BCBS Medicaid | $263 |
| Capital District Physicians Health Plan (Cdphp) 5149 | Capital Distric | $297 |
| Cdphp Medicare 1320 | Cdphp Medicare 132001 | $359 |
| Upmc Health Plan 5138 | Upmc Health Plan 513801 | $418 |
| Excellus Blue Cross Blue Shield 2201, Out Area Blue Cross Blue Shield, | $558 |
| Fidelis Medicare 1311 | Fidelis Medicare 131101 | $558 |
| Humana Medicare 1312 | Humana Medicare 131201 | $558 |
| Wellcare Medicare 1310 | Wellcare Medicare 131001 | $558 |
| United Healthcare Medicare 1309 | United Healthcare Medicare 130901 | $558 |
| Highmark Blue Cross Blue Shield Medicare 1301 | Highmark BCBS Medicare | $558 |
| Medicare Blue Choice 1306 | Medicare Blue Choice 130601 | $558 |
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