Emergency visit, high (level 4) at Adventist Health Clearlake Hospital. CPT 99284.

What Adventist Health Clearlake Hospital publishes for this service, straight from its standard-charges file, last updated July 29, 2026.

Outpatient / ER

$1,473cash price (self-pay)

$4,093list price

$98.04–$31,500range insurers pay

Insurance plan	Negotiated rate
Bc Managed Mcal \| Bc Managed Mcal	$98.04
Medi-Cal \| Medi-Cal	$98.04
Blue Shield Mcr Adv \| Blue Shield Mcr Adv	$860
Kaiser Mcr Adv \| Kaiser Mcr Adv	$860
Tricare Blue Shield- All Plans \| Tricare Blue Shield- All Plans	$860
Blue Cross Mcr Adv \| Blue Cross Mcr Adv	$894
UHC Mcr Adv \| UHC Mcr Adv	$945
Ah Employee Health Plan - All Plans \| Ah Employee Health Plan - All Pl	$1,719
Blue Cross Exchange \| Blue Cross Exchange	$2,013
Blue Cross Non-Mcs \| Blue Cross Non-Mcs	$2,236
Blue Cross Mcs - All Other Plans \| Blue Cross Mcs - All Other Plans	$2,672
Aetna- All Plans \| Aetna- All Plans	$3,058
Western Growers- All Plans \| Western Growers- All Plans	$3,070
UHC Jll \| UHC Jll	$3,243
First Health- All Plans \| First Health- All Plans	$3,274
Healthnet- All Plans \| Healthnet- All Plans	$3,356
UHC All Payer - All Other Plans \| UHC All Payer - All Other Plans	$3,414
Foundation- All Plans \| Foundation- All Plans	$3,479
Health Mgmt Network- All Plans \| Health Mgmt Network- All Plans	$3,479
Humana- All Plans \| Humana- All Plans	$3,479
Phcs- All Plans \| Phcs- All Plans	$3,479
Kaiser- All Other Plans \| Kaiser- All Other Plans	$3,684
Cigna- All Plans \| Cigna- All Plans	$3,684
Interplan- All Plans \| Interplan- All Plans	$3,684
Three Rivers Provider Network- All Plans \| Three Rivers Provider Netwo	$3,684
Blue Shield Epn - All Other Plans \| Blue Shield Epn - All Other Plans	$5,350
Blue Shield Non-Epn \| Blue Shield Non-Epn	$5,584
Partnership Mcal - All Plans \| Partnership Mcal - All Plans	$6,753

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