Emergency visit, high (level 4) at Montclair Hospital Medical Center. CPT 99284.
What Montclair Hospital Medical Center publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$534cash price (self-pay)
$3,410list price
$98.04–$3,410range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Shield Of Promise | Blue Shield Of Promise Medi-Cal | $98.04 |
| Molina | Molina Medi-Cal | $98.04 |
| Traditional Medi-Cal | Traditional Medi-Cal | $98.04 |
| Vantage Care | Vantage Care Medi-Cal | $98.04 |
| Anthem Blue Cross | Anthem Blue Cross Medi-Cal | $103 |
| Health Net Of CA | Health Net Of CA Medi-Cal | $105 |
| Inland Empire Healthplan | Inland Empire Healthplan Medi-Cal | $142 |
| RIOS | RIOS Medicare | $507 |
| Inland Empire Healthplan | Inland Empire Healthplan Medicare | $534 |
| Alignment | Alignment Medicare | $534 |
| Blue Sheild Of CA TriWest Medicare | Blue Sheild Of CA TriWest Medicar | $534 |
| Central Health Plan | Central Health Plan Medicare | $534 |
| Choice Physicians Network | Choice Physicians Network Medicare | $534 |
| Citrus Valley Physicians Group | Citrus Valley Physicians Group Commer | $534 |
| Citrus Valley Physicians Group | Citrus Valley Physicians Group Medi-C | $534 |
| Citrus Valley Physicians Group | Citrus Valley Physicians Group Medica | $534 |
| Elite Health Plan | Elite Health Plan (Medicare) | $534 |
| Emanate Health | Emanate Health Medi-cal | $534 |
| Emanate Health | Emanate Health Medicare | $534 |
| Epic Health Plan | Epic Health Plan Medicare | $534 |
| Health Net Federal Services (Tricare) | Health Net Federal Service Tri | $534 |
| Health Net Of CA | Health Net Of CA Medicare | $534 |
| Inland Empire Foundation For Medical Care | Inland Empire Foundation F | $534 |
| Molina | Molina Exchange | $534 |
| Molina | Molina Medicare | $534 |
| Renal Payor Solution | Renal Payor Solution Medicare | $534 |
| Traditional Medicare | Traditional Medicare | $534 |
| Tricare | Tricare | $534 |
| Vantage Care | Vantage Care Medicare | $534 |
| Brand New Day | Brand New Days Medicare | $539 |
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