Emergency visit, high (level 4) at UPMC Lititz. CPT 99284.
What UPMC Lititz publishes for this service, straight from its standard-charges file, last updated March 6, 2026.
Outpatient / ER
$1,320cash price (self-pay)
$2,200list price
$65.00–$1,870range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $65.00 |
| Highmark Wholecare (prev Gateway) | Medicaid | $105 |
| UPMC Health Plan | Managed Medicaid | $124 |
| United Healthcare Community Plan for Families | PA Medicaid | $125 |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $130 |
| Geisinger | Medicaid/CHIP | $139 |
| UPMC Work Partners | Workers Comp | $176 |
| Highmark BCBS of PA | Medicare | $405 |
| Prime Net | Managed Medicare | $414 |
| Aetna | Medicare | $427 |
| Cigna | Medicare | $429 |
| Geisinger | Medicare | $429 |
| United Healthcare | Medicare | $438 |
| Capital Blue Cross | Medicare Advantage | $440 |
| Keystone Health Plan | Medicare Advantage | $440 |
| UPMC Health Plan | CHIP | $449 |
| Keystone Autism Services | ACAP | $654 |
| Prime Net | Legacy Commercial | $858 |
| Aetna | ACO | $865 |
| Prime Net | ACO | $865 |
| Prime Net | NonGateKeeper | $1,023 |
| Aetna | Commercial | $1,030 |
| Prime Net | GateKeeper | $1,030 |
| Capital Blue Cross | CHIP | $1,032 |
| Capital Blue Cross | Commercial | $1,032 |
| Keystone Health Plan | Commercial | $1,032 |
| Highmark BCBS of PA | Commercial - Children's Health Insurance | $1,209 |
| Preferred Healthcare System | Inter County Health Plan/Lancaster Gener | $1,210 |
| Highmark BCBS of PA | Medicaid | $1,259 |
| Highmark BCBS of PA | Commercial | $1,286 |
Inpatient
$1,320cash price (self-pay)
$2,200list price
$816–$1,870range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Prime Net | Legacy Commercial | $816 |
| Aetna | ACO | $823 |
| Prime Net | ACO | $823 |
| Prime Net | NonGateKeeper | $972 |
| Aetna | Commercial | $979 |
| Prime Net | GateKeeper | $979 |
| Preferred Healthcare System | Inter County Health Plan/Lancaster Gener | $1,210 |
| Geisinger | Commercial | $1,589 |
| Prime Net | FH-Medical Rental | $1,593 |
| Preferred Healthcare System | PPO | $1,650 |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $1,870 |
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