Emergency visit, high (level 4) at Wayne Memorial Hospital. CPT 99284.
What Wayne Memorial Hospital publishes for this service, straight from its standard-charges file, last updated September 16, 2026.
Outpatient / ER
$260cash price (self-pay)
$751list price
$148–$905range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross | Blue Cross | $300 |
| KeyStone First | KEYSTONE FIRST | $300 |
| Upmc | Upmc | $406 |
| MEDICARE ADVANTAGE 100Percentage | MEDICARE ADVANTAGE 100Percentage | $444 |
| Humana | Humana | $448 |
| Upmc Medicare | Upmc Medicare | $461 |
| Ambetter | AMBETTER | $470 |
| Pa Health & Wellness | Pa Health Wellness | $470 |
| Geisinger | Geisinger | $518 |
| Cigna | Cigna | $526 |
| Phcs | Phcs | $526 |
| Self-Pay | Self-Pay | $526 |
| Aetna | Aetna | $563 |
| WELLPATH (State Prison) | WELLPATH (State Prison) | $577 |
| MultiPlan | MULTIPLAN | $601 |
| UHC | UHC | $792 |
| WELLPATH (Federal Prison) | WELLPATH (Federal Prison) | $821 |
Inpatient
$260cash price (self-pay)
$751list price
$148–$905range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| KeyStone First | KEYSTONE FIRST | $300 |
| Phcs | Phcs | $526 |
| Self-Pay | Self-Pay | $526 |
| MultiPlan | MULTIPLAN | $601 |
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