Emergency visit, high (level 4) at Pennsylvania Hospital. CPT 99284.
What Pennsylvania Hospital publishes for this service, straight from its standard-charges file, last updated March 20, 2026.
Outpatient / ER
$2,662cash price (self-pay)
$2,662list price
$90.00–$3,873range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quest Behavioral Health | Quest Behavioral Health | $90.00 |
| PA Medical Assistance | Medicaid | $95.33 |
| Managed Medicaid Other | Managed Medicaid Other | $95.33 |
| PA Health and Wellness Medicaid | PA Health and Wellness Medicaid | $110 |
| Keystone Mercy Health Plan | Keystone Mercy Health Plan | $122 |
| United Behavioral Health | United Behavioral Health | $200 |
| UPMC | UPMC Medicaid | $309 |
| TriCare | TriCare | $439 |
| Horizon NJ Health | Horizon NJ Health | $468 |
| US Family Health Plan | US Family Health Plan | $504 |
| UnitedHealthcare Community (fka AmeriChoice MA) | UnitedHealthcare Com | $534 |
| UnitedHealthcare | UnitedHealthcare Compass Exchange | $571 |
| PGM - Regie de l'assurance Maladie Quebec | PGM - Regie de lassurance | $612 |
| Preferred Health Care Eliance | Preferred Health Care Eliance | $692 |
| PGM - Kuwait Defense | PGM - Kuwait Defense | $932 |
| UnitedHealthcare New Business | UnitedHealthcare New Business | $948 |
| IBC Commercial HPN | IBC Commercial HPN | $999 |
| Qualcare | Qualcare | $1,012 |
| Independence Blue Cross/Personal Choice | Personal Choice-IBC PPO | $1,024 |
| Keystone HMO Proactive | Keystone HMO Proactive | $1,024 |
| Independence Blue Cross/Keystone Health Plan East | Keystone Health Pl | $1,024 |
| Wissahickon Hospice | Wissahickon Hospice | $1,065 |
| Pgm - Chop | Pgm - Chop | $1,065 |
| Olympus | Olympus | $1,294 |
| URN-Cancer Resource Services | URN-Cancer Resource Services | $1,331 |
| UnitedHealthcare Non Options | UnitedHealthcare Non Options | $1,485 |
| PGM - Royal Embassy of Saudi Arabia | PGM - Royal Embassy of Saudi Ara | $1,597 |
| PGM - Ontario Ministry of Health and Long-Term Care (OHIP) | PGM - Ont | $1,730 |
| PGM - Embassy of Qatar | PGM - Embassy of Qatar | $1,730 |
| PGM - Embassy of the United Emirates/IPC | PGM - Embassy of the United | $1,863 |
Inpatient
$2,662cash price (self-pay)
$2,662list price
$450–$2,662range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Horizon NJ Health | Horizon NJ Health | $450 |
| PGM - Regie de l'assurance Maladie Quebec | PGM - Regie de lassurance | $612 |
| Preferred Health Care Eliance | Preferred Health Care Eliance | $692 |
| Devon | Devon Premier | $1,012 |
| Pgm - Chop | Pgm - Chop | $1,065 |
| Coventry | HealthAmerica/Coventry SEPA | $1,065 |
| PGM - Kuwait Defense | PGM - Kuwait Defense | $1,198 |
| HealthAmerica/Coventry | HealthAmerica/HealthAssurance | $1,304 |
| URN-Cancer Resource Services | URN-Cancer Resource Services | $1,331 |
| First Health Global | First Health Global | $1,331 |
| Coventry | Coventry of Delaware | $1,358 |
| PGM - Royal Embassy of Saudi Arabia | PGM - Royal Embassy of Saudi Ara | $1,597 |
| Health Net | Health Net | $1,597 |
| PGM - Ontario Ministry of Health and Long-Term Care (OHIP) | PGM - Ont | $1,730 |
| Preferred Care | Preferred Care | $2,130 |
| PGM - Kuwait Oil | PGM - Kuwait Oil | $2,130 |
| PGM - Kuwait Health Division | PGM - Kuwait Health Division | $2,130 |
| Intergroup | Intergroup | $2,130 |
| Humana Choice Care | Humana Choice Care | $2,130 |
| Health America/CCN | First Health/ Coventry National | $2,130 |
| Devon Health Services Inc | Devon Health Services | $2,130 |
| UPMC | UPMC Medicaid | $2,662 |
| UnitedHealthcare Non Options | UnitedHealthcare Non Options | $2,662 |
| United Behavioral Health | United Behavioral Health | $2,662 |
| Quest Behavioral Health | Quest Behavioral Health | $2,662 |
| Managed Medicaid Other | Managed Medicaid Other | $2,662 |
| International PFS | International PFS | $2,662 |
| Horizon Blue Cross of New Jersey | Horizon Blue Cross of NJ-PPO | $2,662 |
| Horizon Blue Cross of New Jersey | Horizon Blue Cross of NJ-Indemnity | $2,662 |
| Health Partners | Health Partners Medicaid | $2,662 |
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