Emergency visit, high (level 4) at St. Mary Medical Center. CPT 99284.
What St. Mary Medical Center publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$40.48cash price (self-pay)
$253list price
$5.83–$1,684range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Highmark Wholecare Medicaid | Gateway Health Medicaid | $50.00 |
| Upmc Medicaid Advantage | Upmc Health Plan Medicaid | $75.00 |
| Allwell Pa Health & Wellness Medicaid Advantage | Pa Health And Wellne | $75.00 |
| Aetna Medicaid | Aetna Better Health Medicaid | $300 |
| Jefferson Health Plans Medicaid | Health Partners Medicaid | $320 |
| Keystone First | Keystone Medicaid | $429 |
| Keystone First Chc Medicaid | Keystone Medicaid | $429 |
| Blue Cross - Pa (Independence) Medicare Advantage | Independence Blue | $450 |
| Cigna Medicare Advantage | Cigna Healthspring Medicare Advantage | $454 |
| Align Senior Care | Ally Align Health | $459 |
| Devoted Health Medicare Advantage | Devoted Health Medicare Advantage | $461 |
| Keystone First Chc Medicare Advantage | Keystone First Medicare Advant | $463 |
| Aetna Medicare Advantage | Aetna Medicare Advantage | $476 |
| Health Partners Medicare Advantage | Health Partners Medicare Advantag | $477 |
| Jefferson Health Plans Medicare | Health Partners Medicare Advantage | $477 |
| Allwell Medicare Advantage | Pa Health & Wellness Medicare Advantage | $495 |
| Allwell Pa Health & Wellness Medicare Advantage | Pa Health & Wellness | $495 |
| Upmc Medicare Advantage | Upmc Health Plan Medicare Advantage | $517 |
| Highmark Wholecare Medicare Advantage | Highmark Wholecare Medicare Ad | $517 |
| Coventry Medicare Advantage | Coventry Advantra Medicare Advantage | $540 |
| Health America Advantra | Health America Medicare Advantage | $540 |
| Amerihealth | Independence Blue Cross HMO/PPO | $746 |
| Blue Cross - Co (Anthem) | Independence Blue Cross HMO/PPO | $746 |
| Blue Cross - Nv (Anthem) | Independence Blue Cross HMO/PPO | $746 |
| Blue Cross - Nh (Anthem) | Independence Blue Cross HMO/PPO | $746 |
| Blue Cross - La | Independence Blue Cross HMO/PPO | $746 |
| Blue Cross - Md (Carefirst) | Independence Blue Cross HMO/PPO | $746 |
| Blue Cross - Id | Independence Blue Cross HMO/PPO | $746 |
| Blue Shield - Id (Regence) | Independence Blue Cross HMO/PPO | $746 |
| Blue Cross - Ky (Anthem) | Independence Blue Cross HMO/PPO | $746 |
Inpatient
$250cash price (self-pay)
$250list price
$76.68–$250range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Paramount Medicaid Advantage | Medicaid | $95.33 |
| Total Health Care Medicaid | Medicaid | $95.33 |
| Positive Healthcare Partners Medicaid | Medicaid | $95.33 |
| Amerigroup Medicaid | Medicaid | $95.33 |
| Cmh Ottawa County | Medicaid | $95.33 |
| Cmh Oakland County | Medicaid | $95.33 |
| Cmh Van Buren County | Medicaid | $95.33 |
| Cmh Washtenaw County | Medicaid | $95.33 |
| Cmh Montcalm County | Medicaid | $95.33 |
| Cmh Muskegon County | Medicaid | $95.33 |
| Cmh Newaygo County | Medicaid | $95.33 |
| Delta Dental Nj | Medicaid | $95.33 |
| Freedom First Healthcare | Medicaid | $95.33 |
| Fallon Health Medicaid Advantage | Medicaid | $95.33 |
| Community Care Plan Medicaid Advantage | Medicaid | $95.33 |
| Rx Allwin | Medicare | $120 |
| Molina Medicare Advantage | Medicare | $120 |
| Eddy Seniorcare Pace | Medicare | $120 |
| Healthsun Medicare Advantage | Medicare | $120 |
| Aurora Special Needs | Medicare | $120 |
| Life St Marys Pace | Medicare | $120 |
| Align Senior Care | Medicare | $120 |
| Unicare Medicare Advantage | Medicare | $120 |
| Wellmed | Medicare | $120 |
| Positive Healthcare Partners Medicare | Medicare | $120 |
| Union Health Service | Medicare | $120 |
| Lifecircles Pace | Medicare | $120 |
| Commonwealth Care Alliance | Medicare | $120 |
| Total Healthcare Medicare Snp | Medicare | $120 |
| Medicare Puerto Rico | Medicare | $120 |
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