Emergency visit, high (level 4) at Roxborough Memorial Hospital. CPT 99284.
What Roxborough Memorial Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$426cash price (self-pay)
$2,099list price
$95.33–$2,036range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Traditional Medicaid | Traditional Medicaid | $95.33 |
| UHC | UHC Medicaid | $108 |
| Health Partners Plan | Health Partners Plan Medicaid | $334 |
| Humana Military Tricare | Humana Military Tricare | $341 |
| PA Health & Wellness | PA Health & Wellness Medicaid | $380 |
| Keystone | Keystone First Medicaid | $387 |
| Health Partners Plan | Health Partners Plan Medicare | $427 |
| Independence Blue Cross | IBC Medicare | $427 |
| PA Health & Wellness | PA Health & Wellness Medicare & Duals | $427 |
| Traditional Medicare | Traditional Medicare | $427 |
| Tricare | Tricare | $427 |
| UHC | UHC Medicare | $427 |
| UHC | UHC Va Ccn | $427 |
| Providers Partner Health Plan | Provider Partners Health Plan | $439 |
| Keystone | Keystone First Medicare | $444 |
| Ally-Align Medicare | Ally-Align Medicare | $448 |
| Spartan | Spartan Plan | $448 |
| Auto Insurance | Auto Insurance | $469 |
| Worker Compensation | Worker Compensation | $482 |
| PA Health & Wellness | PA Health & Wellness Commercial Insurance Excha | $512 |
| Employer Direct Healthcare | Employer Direct Healthcare | $597 |
| Health Partners Plan | Health Partners Plan Exchange | $640 |
| Naphcare | Naphcare | $661 |
| Independence Blue Cross | IBC PPACA | $666 |
| UHC | UHC Exchange | $671 |
| Independence Blue Cross | IBC Commercial HMO PPO | $886 |
| Independence Blue Cross | IBC Indemnity | $886 |
| UHC | UHC Commercial All Payer | $892 |
| Highmark | Highmark Commercial (02-01-2024 to 12-31-2026) | $929 |
| Cigna | Cigna Commercial (05-01-2023 to 12-31-2026) | $1,009 |
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