Emergency visit, high (level 4) at Suburban Behavioral Health Campus of Roxborough Memorial Hospital. CPT 99284.
What Suburban Behavioral Health Campus of 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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All common services at Suburban Behavioral Health Campus of Roxborough Memorial Hospital