Emergency visit, high (level 4) at Mary Imogene Bassett Hospital. CPT 99284.
What Mary Imogene Bassett Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$108cash price (self-pay)
$666list price
$98.57–$2,389range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Mvp | Managed Medicaid | $98.57 |
| BCBS | Excellus Preferred | $120 |
| United Healthcare | NY Power Authority | $165 |
| Cigna | Assurant | $183 |
| Mvp | Preferred | $183 |
| BCBS | Excellus HMO Blue Option Managed Medicaid | $261 |
| BCBS | Excellus Blue | $426 |
| BCBS | Excellus Medicare Advantage | $426 |
| Aetna | Medicare Advantage | $540 |
| BCBS | Anthem Medicare Advantage | $540 |
| BCBS | Excellus Blue Medicare Advantage | $540 |
| BCBS | Highmark Medicare Advantage | $540 |
| Cdphp | Medicare Advantage | $540 |
| Emblem | Medicare Advantage | $540 |
| Fidelis | Medicare Advantage | $540 |
| Humana | Medicare Advantage | $540 |
| Mvp | Medicare Advantage | $540 |
| United Healthcare | Madicare Advantage | $540 |
| BCBS | Highmark | $630 |
| Cigna | Mvp | $714 |
| BCBS | Anthem Exchange | $2,389 |
| BCBS | Empire Exchange | $2,389 |
| BCBS | Empire Managed Medicaid | $2,389 |
Inpatient
$108cash price (self-pay)
$216list price
$45.02–$194range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS | Anthem Medicare Advantage | $96.04 |
| BCBS | Excellus Blue Medicare Advantage | $96.04 |
| BCBS | Excellus Blue Medicare Advantage PPO | $96.04 |
| BCBS | Excellus Medicare Advantage HMO/POS | $96.04 |
| BCBS | Excellus Medicare Advantage PPO | $96.04 |
| BCBS | Highmark Medicare Advantage | $96.04 |
| BCBS | Excellus Child Health Plus Managed Medicaid | $99.14 |
| BCBS | Excellus Essential Managed Medicaid | $99.14 |
| BCBS | Excellus Healthy NY EPO Managed Medicaid | $99.14 |
| BCBS | Excellus Healthy NY Managed Medicaid | $99.14 |
| BCBS | Excellus HMO Blue Option Managed Medicaid | $99.14 |
| BCBS | Excellus Safety Net | $99.14 |
| Cdphp | Child Health Plus | $107 |
| Cdphp | Managed Medicaid | $107 |
| BCBS | Excellus Sr Federal | $113 |
| Cdphp | Medicare Advantage HMO | $113 |
| Cdphp | Medicare Advantage PPO | $113 |
| Aetna | Medicare Advantage HMO | $116 |
| Aetna | Medicare Advantage PPO/EPO | $116 |
| Cdphp | Essentials | $129 |
| BCBS | Excellus Preferred | $137 |
| BCBS | Excellus | $146 |
| BCBS | Excellus Alliance | $146 |
| BCBS | Excellus Blue Card | $146 |
| BCBS | Excellus Exchange | $146 |
| BCBS | Excellus Federal | $146 |
| BCBS | Excellus HMO Blue Access | $146 |
| BCBS | Excellus PPO/EPO | $146 |
| BCBS | Excellus Preferred PPO | $146 |
| BCBS | Empire Exchange | $159 |
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