Emergency visit, high (level 4) at Dominican Hospital. CPT 99284.

What Dominican Hospital publishes for this service, straight from its standard-charges file, last updated February 28, 2026.

Outpatient / ER

$2,792cash price (self-pay)

$6,204list price

$98.04–$14,940range insurers pay

Insurance plan	Negotiated rate
BCBS - Anthem \| Medicaid\|All Plans	$98.04
COSC Psych \| Medicaid\|All Plans	$98.04
Central California Alliance for Health \| Medicaid\|All Plans	$98.04
Health Net \| Medicaid\|< 21	$148
Health Net \| Medicaid\|> 21	$148
Blue Shield CA \| Medicare\|All Plans	$585
Health Net \| Medicare\|All Plans	$585
Kaiser \| Medicare\|All Plans	$585
United \| Medicare\|All Plans	$585
Blue Shield CA \| Commercial\|DHMF	$667
Sutter Health \| Commercial\|All Plans	$1,831
Aetna \| Commercial\|HMO	$2,668
Aetna \| Commercial\|PPO	$2,668
Blue Shield CA \| Commercial\|ACO Trio	$3,660
Cigna \| Commercial\|LocalPlus	$3,722
Blue Shield CA \| Commercial\|Exchange	$3,784
Cigna \| Commercial\|All Other Plans	$3,971
Western Growers \| Commercial\|All Plans	$4,219
Blue Shield CA \| Commercial\|All Other Plans	$4,467
Kaiser \| Commercial\|All Plans	$4,653
Healthsmart \| Commercial\|All Plans	$4,963
First Health \| Commercial\|All Plans	$5,273
Multiplan \| Commercial\|All Plans	$5,273
United \| Commercial\|HMO	$7,166
Health Net \| Commercial\|Community Care	$9,377
BCBS - Anthem \| Commercial\|All Other Plans	$9,417
Health Net \| Commercial\|Care Product	$11,417
Health Net \| Commercial\|Blue Gold	$11,551
United \| Commercial\|Non-Options PPO	$12,322
Health Net \| Commercial\|All Other Plans	$12,686

$2,792cash price (self-pay)

$6,204list price

$3,722–$5,273range insurers pay

Insurance plan	Negotiated rate
Kaiser \| Commercial\|All Plans	$3,722
Healthsmart \| Commercial\|All Plans	$4,963
First Health \| Commercial\|All Plans	$5,273
Multiplan \| Commercial\|All Plans	$5,273

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