Emergency visit, high (level 4) at Mount St. Mary's Hospital. CPT 99284.

What Mount St. Mary's Hospital publishes for this service, straight from its standard-charges file, last updated April 1, 2026.

Outpatient / ER

$284cash price (self-pay)

$284list price

$40.54–$1,878range insurers pay

Insurance plan	Negotiated rate
Hospice [550001] \| Erie [55000101]	$115
Hospice [550001] \| Niagara [55000102]	$115
BCBS Community Blue [100173] \| Community Blue POS [10017310]	$148
BCBS Community Blue [100173] \| Out Of Area HMO/POS/Bc [10017303]	$148
Wellpoint Bc Medicaid [351102] \| Wellpoint Bc Chp Non-Medicaid [351102	$242
Amerigroup [350102] \| Chp BCBS Amg Non Mcd [35010202]	$242
Wellpoint Bc Medicaid [351102] \| Wellpoint Bc Chp Medicaid [35110202]	$242
Wellpoint Bc Medicaid [351102] \| Wellpoint Bc Medicaid [35110201]	$242
Amerigroup [350102] \| Chp BCBS Amg Mcd [35010201]	$242
Amerigroup [350102] \| BCBS Amerigroup Mcd [35010203]	$242
Fidelis Exchange [100164] \| Fidelis Exchange [10016401]	$459
Affinity Health Plan [100129] \| Affinity Essential Exchange [10012901]	$616
Commercial - Other [100172] \| Gerber Life Ins [10017202]	$616
Commercial - Other [100172] \| Healthsource [10017204]	$616
Humana [100052] \| Humana One [10005203]	$616
Commercial - Other [100172] \| Guardian [10017203]	$616
Commercial - Other [100172] \| Metrahealth [10017208]	$616
Commercial - Other [100172] \| Pomco [10017213]	$616
Commercial - Other [100172] \| Healthy Living Partnershi [10017212]	$616
Commercial - Other [100172] \| Mutual Of Omaha [10017211]	$616
Core Source [100161] \| Core Source [10016101]	$616
Fireman'S Fund [100162] \| Fireman'S Fund [10016201]	$616
Aarp [100007] \| Aarp [10000701]	$616
Baker/Confectionary Union [100158] \| Baker/Confectionary Union [100158	$616
Commercial - Other [100172] \| Board Of Pensions [10017201]	$616
Commercial - Other [100172] \| Optum Behavioral Health [10017210]	$616
Humana [100052] \| Humana HMO/POS [10005201]	$616
Commercial - Other [100172] \| Sunshine State Health Pln [10017207]	$616
Commercial - Other [100172] \| Upstate Administrative [10017206]	$616
National Association Of Letter Carriers [100067] \| Nalc Health Benefit	$616

Inpatient

$284cash price (self-pay)

$284list price

$40.54–$1,878range insurers pay

Insurance plan	Negotiated rate
BCBS Essential [100152] \| Bc Essential Plan 1 And 2 [10015201]	$40.54
Independent Health Medicaid [350106] \| Medisource [35010601]	$42.34
Independent Health Essential [100166] \| Iha Essential Plan 1 And 2 [10	$42.34
Univera Healthcare Medicaid [350108] \| Child Health Plus Univera Non M	$42.77
Medicaid In State [300001] \| Nys Medical Assistance [30000102]	$42.77
Medicaid Out Of State [309999] \| Medicaid Out Of State [30999901]	$42.77
Univera Healthcare Medicaid [350108] \| Univera Mcd Myhealth [35010802]	$42.77
Excellus Rochester Medicaid [350112] \| Excellus Rochester Medicaid [35	$42.77
Medicaid Out Of State [309999] \| Medicaid Florida [30999905]	$42.77
Tuscarora Nation [550120] \| Tuscarora Nation Plan [55012005]	$42.77
BCBS Medicaid [350103] \| Bc Ooa Medicaid [35010301]	$42.77
BCBS Medicare [450116] \| Federal Bc Over 65 [45011602]	$90.39
Va Veterans Affairs [700001] \| Va [70000101]	$97.39
Beacon Essential [350122] \| Beacon Essential Plan 3 And 4 [35012202]	$97.39
Excellus Rochester Medicare [450128] \| Excellus Rochester Medicare [45	$97.39
Medicare [400001] \| Medicare Part A And B [40000101]	$97.39
Medicare Alternate Payor [888] \| Medicare Part B Alternate [88801]	$97.39
Medicare HMO Other [450117] \| Medicare HMO Other [45011701]	$97.39
Beacon Health Options [100023] \| Beacon Health Options [10002302]	$97.39
Tricare [600100] \| Tricare [60010002]	$97.39
Beacon Essential [350122] \| Beacon Essential Plan 1 And 2 [35012201]	$97.39
Univera Healthcare [100169] \| Univera Access [10016908]	$98.57
Magnacare [100142] \| Magnacare [10014201]	$102
Aetna [100001] \| Aetna PPO [10000101]	$102
Aetna Medicare HMO [450112] \| Aetna Medicare HMO [45011201]	$102
United Healthcare [100154] \| United Healthcare [10015402]	$106
Wellcare [450129] \| Wellcare HMO [45012901]	$107
Blue Cross/Blue Shield [100151] \| BCBS Of Mich [10015110]	$118
Blue Cross/Blue Shield [100151] \| Blue Cross/Blue Shield [10015101]	$118
Blue Cross/Blue Shield [100151] \| Out Of Area Traditional B/C [1001510	$118

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All common services at Mount St. Mary's Hospital