Emergency visit, high (level 4) at UPMC Wellsboro. CPT 99284.
What UPMC Wellsboro publishes for this service, straight from its standard-charges file, last updated March 6, 2026.
Outpatient / ER
$214cash price (self-pay)
$1,880list price
$55.00–$1,969range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $55.00 |
| Geisinger | Medicaid/CHIP | $105 |
| UPMC Health Plan | CHIP | $105 |
| UPMC Health Plan | Managed Medicaid | $105 |
| Highmark Wholecare (prev Gateway) | Medicaid | $106 |
| United Healthcare Community Plan for Families | PA Medicaid | $122 |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $144 |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $162 |
| UPMC Work Partners | Workers Comp | $168 |
| Aetna | Medicare | $252 |
| Highmark BCBS of PA | Medicare | $280 |
| Highmark Wholecare (prev Gateway) | Medicare | $280 |
| UPMC Health Plan | Managed Medicare | $286 |
| Cigna | Medicare | $294 |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advant | $303 |
| United Healthcare | Medicare | $423 |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $602 |
| UPMC Health Plan | Commercial | $611 |
| Highmark BCBS of PA | Commercial | $709 |
| Wirerope Works | Commercial | $779 |
| Geisinger | Commercial | $939 |
| Aetna | PEBTF Custom Network | $1,028 |
| Multiplan | Auto | $1,093 |
| Multiplan | PPO (Includes PHCS as a Payer) | $1,093 |
| United Healthcare | Commercial | $1,191 |
| Aetna | Commercial | $1,209 |
| America's Choice | PPO | $1,261 |
| InterGroup | PPO | $1,261 |
| Multiplan | Worker's Compensation | $1,331 |
Inpatient
$214cash price (self-pay)
$1,402list price
$198–$1,969range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Wirerope Works | Commercial | $779 |
| Aetna | PEBTF Custom Network | $1,028 |
| Multiplan | Auto | $1,093 |
| Multiplan | PPO (Includes PHCS as a Payer) | $1,093 |
| United Healthcare | Commercial | $1,191 |
| Aetna | Commercial | $1,209 |
| America's Choice | PPO | $1,261 |
| InterGroup | PPO | $1,261 |
| Multiplan | Worker's Compensation | $1,331 |
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