Emergency visit, high (level 4) at Gifford Medical Center. CPT 99284.
What Gifford Medical Center publishes for this service, straight from its standard-charges file, last updated February 12, 2026.
Outpatient / ER
$213cash price (self-pay)
$425list price
$112–$2,118range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross Blue Shield of New Hampshire | Qualified Health Plan | $188 |
| Blue Cross Blue Shield of Vermont | Medicare Advantage | $191 |
| Martins Point Health Care | Commercial | $191 |
| MVP Health Care of NY | Medicare Advantage | $191 |
| United Healthcare | Medicare Advantage | $191 |
| United Healthcare | VA CCN | $191 |
| Blue Cross Blue Shield of New Hampshire | SHOP On Exchange | $256 |
| Blue Cross Blue Shield of Vermont | Vermont Health Plan | $338 |
| Cigna | Commercial | $340 |
| Harvard Pilgrim Health Care | HMO | $340 |
| Harvard Pilgrim Health Care | PPO | $340 |
| Blue Cross Blue Shield of Vermont | Managed Care | $344 |
| Blue Cross Blue Shield of Vermont | Commercial | $361 |
| MVP Health Care of NY | Commercial | $361 |
| Blue Cross Blue Shield of New Hampshire | Commercial | $381 |
| Blue Cross Blue Shield of New Hampshire | SHOP Off Exchange | $381 |
| Multiplan | Commercial | $395 |
| Aetna of VT | Commercial | $404 |
| United Healthcare | Commercial | $404 |
Inpatient
$213cash price (self-pay)
$700list price
$315–$2,118range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross Blue Shield of New Hampshire | Commercial | $518 |
| Blue Cross Blue Shield of New Hampshire | SHOP Off Exchange | $518 |
| Blue Cross Blue Shield of Vermont | Vermont Health Plan | $560 |
| Cigna | Commercial | $560 |
| Harvard Pilgrim Health Care | HMO | $560 |
| Harvard Pilgrim Health Care | PPO | $560 |
| Blue Cross Blue Shield of Vermont | Managed Care | $588 |
| Blue Cross Blue Shield of Vermont | Commercial | $595 |
| MVP Health Care of NY | Commercial | $595 |
| Multiplan | Commercial | $651 |
| Aetna of VT | Commercial | $665 |
| United Healthcare | Commercial | $665 |
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