Emergency visit, high (level 4) at Pomerene Hospital. CPT 99284.
What Pomerene Hospital publishes for this service, straight from its standard-charges file, last updated March 24, 2026.
Outpatient / ER
$323cash price (self-pay)
$574list price
$62.91–$691range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Buckeye Ohio Medicaid MCE | Default | $62.91 |
| CareSource OH MCE | Default | $62.91 |
| Medicaid Ohio | Default | $62.91 |
| Paramount Care MCD Rep | Default | $62.91 |
| AmeriHealth Caritas Ohio - Nontransportation MCE | Default | $66.06 |
| Molina Healthcare of Ohio MCD Rep | Default | $66.06 |
| Medicare B OH J15 | Default | $115 |
| AultCare MA | Default | $251 |
| Blue Cross Blue Shield of OH Anthem MCR Adv | Default | $251 |
| Humana Advantage Care Plans Med Advantage | Default | $251 |
| Medical Mutual of Ohio MCR Adv | Default | $251 |
| Molina Healthcare of Ohio MCR Adv | Default | $251 |
| SummaCare Health Plan MA | Default | $251 |
| Aetna Medicare Advantage | Default | $255 |
| UHC Group Medicare Advantage | Default | $255 |
| Optum Medical Network (Lifeprint) | Default | $256 |
| Medical Mutual of Ohio | Default | $380 |
| Medicare A OH J15 | Default | $387 |
| VALOR HEALTH PLAN | Default | $387 |
| UHC Community Plan Ohio | Default | $404 |
| Cigna | Default | $464 |
| Blue Cross Blue Shield of OH Anthem | Default | $479 |
| AultCare | Default | $499 |
| Aetna | Default | $505 |
| United Healthcare | Default | $505 |
| SummaCare Health Plan | Default | $533 |
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