Emergency visit, high (level 4) at Nicholas H Noyes Memorial Hospital. CPT 99284.
What Nicholas H Noyes Memorial Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$202cash price (self-pay)
$452list price
$32.52–$1,239range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup (Blue Cross Blue Shield Wny Alternate) 1720 | Amerigroup (B | $40.54 |
| Excellus Medicaid 1706, Excellus Blue Cross Blue Shield 2201 | Blue Ch | $45.02 |
| United Healthcare Medicaid 1716, United Healthcare 5158 | United Healt | $46.92 |
| Mvp Medicaid 1712, Mvp 2900 | Mvp Option Medicaid 171201, Mvp Essentia | $91.27 |
| Capital District Physicians (Cdphp) Medicaid 1704 | Capital District P | $103 |
| Highmark Blue Cross Blue Shield Of Western NY Medicare 1301 | Highmark | $105 |
| 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 |
| United Healthcare Medicare 1309 | United Healthcare Medicare 130901, S | $116 |
| Empire Plan 5179, Empire Plan UHC 5180 | Empire Plan 517901, Empire Pl | $118 |
| Fidelis Medicaid 1708, Fidelis 5155 | Fidelis Essential (W/ Medicaid) | $122 |
| Aetna 2700 | Aetna Chickering 270001,Aetna 270002,Aetna Ur 270003,Aetn | $122 |
| Lifetime Benefit Solutions 2200,Excellus Blue Cross Blue Shield 2201,O | $125 |
| Umr 5142, Pomco Ins Co 5157, United Healthcare 5158 | Umr 514201, Pomc | $147 |
| Mvp 2900, Cigna 5144 | Mvp Commercial Non PPO Fully Insured 290001, Mv | $154 |
| Independent Health 5156 | Independent Health (Buffalo NY) 515601 | $155 |
| Fidelis 5155 | Fidelis Metal Tiers 515501 | $157 |
| Independent Health 5156 | Independent Health (Buffalo NY) 515601,Nova | $158 |
| Capital District Physicians Health Plan (Cdphp) 5149 | Capital Distric | $297 |
| Cdphp Medicare 1320 | Cdphp Medicare 132001 | $339 |
| Medicare Blue Choice 1306 | Medicare Blue Choice 130601 | $427 |
| Aetna Medicare 1300 | Aetna Medicare 130001 | $521 |
| Humana Medicare 1312 | Humana Medicare 131201 | $521 |
| Wellcare Medicare 1310 | Wellcare Medicare 131001 | $521 |
| United Healthcare Medicare 1309 | United Healthcare Medicare 130901 | $521 |
| Fidelis Medicare 1311 | Fidelis Medicare 131101 | $521 |
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