Emergency visit, high (level 4) at Diley Ridge Medical Center. CPT 99284.
What Diley Ridge Medical Center publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$1,967cash price (self-pay)
$3,026list price
$354–$3,820range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United Healthcare Medicare | United Healthcare Medicare Advantage | $402 |
| Hospice Mount Carmel | Mount Carmel Hospice | $402 |
| Molina Medicare Advantage | Molina Medicare Advantage | $414 |
| Crime Victim Assistance | Safe Program | $632 |
| Ohio Safe Program | Safe Program | $632 |
| Blue Cross - Oh (Anthem) | Anthem BCBS Pathway HMO Hx | $704 |
| Quality Care Partners | Quality Care Partners | $909 |
| Blue Cross - Oh (Anthem) | Anthem BCBS Pathway Grp HMO | $1,248 |
| Blue Cross - Ne | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Cross - Oh (Anthem) | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Cross - Nm | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Care Network | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Cross - De (Highmark) | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Cross - Dc (Carefirst) | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Cross - FL | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Cross - Ga (Anthem) | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Cross - Vt | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Cross - NY (Anthem) | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Cross - NY (Excellus) | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Shield - NY Highmark Western | Anthem Blue Access PPO Blue Pref H | $1,501 |
| Blue Shield - NY Highmark Northeastern | Anthem Blue Access PPO Blue P | $1,501 |
| Blue Cross - Ok | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Cross - Or (Regence) | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Cross - La | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Cross - Hi | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Cross - Id | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Shield - Id (Regence) | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Cross - Ky (Anthem) | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Cross - Va (Anthem) | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
| Blue Cross - Va (Carefirst) | Anthem Blue Access PPO Blue Pref HMO | $1,501 |
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