Emergency visit, high (level 4) at Pelham Medical Center. CPT 99284.
What Pelham Medical Center publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$1,484cash price (self-pay)
$2,474list price
$398–$1,725range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Humana | Medicare Managed Care Plan | $398 |
| Bcbs | Medicare Managed Care Plan | $401 |
| Devoted Health Plan | Medicare Managed Care Plan | $410 |
| Aetna | Medicare Managed Care Plan | $414 |
| Absolute Total Care | Medicare Managed Care Plan | $418 |
| Cigna | Healthspring Medicare Managed Care Plan | $426 |
| Bcbs | State Health Plan Other Commercial Plan | $702 |
| Bcbs | Blue Preferred Exchange | $1,303 |
| Bcbs | Bluechoice Exchange | $1,303 |
| Bcbs | Blue Preferred Ppo | $1,725 |
| Bcbs | Bluechoice Hmo | $1,725 |
| Bcbs | Innovations Other Commercial Plan | $1,725 |
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