Emergency visit, high (level 4) at WellSpan Surgery & Rehabilitation Hospital. CPT 99284.
What WellSpan Surgery & Rehabilitation Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$2,678cash price (self-pay)
$3,348list price
$119–$3,248range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $119 |
| Geisinger_Medicaid | All_Plans | $119 |
| Health_Partners_Medicaid | All_Other_Plans | $119 |
| PA_Health_&_Wellness_Medicaid | All_Plans | $119 |
| UPMC_Medicaid | All_Plans | $119 |
| Amerihealth_Caritas_Medicaid | All_Plans | $135 |
| Blue_Cross_BlueJourney_Medicare | All_Plans | $412 |
| Johns_Hopkins_HealthCare_Plan | Johns_Hopkins_US_Family_Health | $412 |
| Highmark_Medicare | All_Plans | $416 |
| Aetna_Better_Health_Kids | All_Plans | $418 |
| Aetna_Advantra_Medicare | All_Plans | $425 |
| Aetna_Medicare | All_Plans | $425 |
| Geisinger_Gold_Medicare | All_Plans | $433 |
| Devoted_Medicare | All_Plans | $433 |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $435 |
| Amerihealth_Medicare | All_Plans | $435 |
| Jefferson_Health_Medicare_Advantage | All_Plans | $445 |
| PA_Health_&_Wellness_Medicare | All_Plans | $445 |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $497 |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $497 |
| Highmark | Higmark_Healthy_Kids | $631 |
| Health_Partners_Medicaid | Kidz_Partners | $680 |
| United_Medicaid | Community_Plan_For_Kids | $721 |
| Highmark | Choice_Blue_PPO | $1,613 |
| Highmark | Performance_Blue | $1,613 |
| Highmark | Blue_Cross_High_Performance_Network | $1,613 |
| Blue_Cross | Capital_Cares_4_kids | $1,880 |
| Highmark | All_Other_Plans | $2,054 |
| Blue_Cross | All_Other_Plans | $2,685 |
| Blue_Cross | Capital_Blue_Performance_PPO | $2,685 |
Inpatient
$2,678cash price (self-pay)
$3,348list price
$1,938–$3,181range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue_Cross | Capital_Blue_Performance_PPO | $1,938 |
| Blue_Cross | Capital_Cares_4_kids | $1,978 |
| Aetna | All_Plans | $2,963 |
| First_Health_Network | All_Plans | $2,963 |
| Cigna | All_Plans | $3,001 |
| Blue_Cross | All_Other_Plans | $3,001 |
| UPMC | UPMC_For_Kids | $3,114 |
| UPMC | All_Plans | $3,114 |
| Geisinger | All_Plans | $3,135 |
| Johns_Hopkins_HealthCare_Plan | All_Other_Plans | $3,181 |
| PHC | All_Plans | $3,181 |
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All common services at WellSpan Surgery & Rehabilitation Hospital