Emergency visit, high (level 4) at Providence Little Co of Mary Med Center San Pedro. CPT 99284.
What Providence Little Co of Mary Med Center San Pedro publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$1,169cash price (self-pay)
$3,341list price
$537–$1,148range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | Medicare Managed Care Plan | $537 |
| Humana | Medicare Managed Care Plan | $547 |
| Blue Cross | Anthem Vivity City Of La Other Commercial Plan | $562 |
| Caremore | Medicare Managed Care Plan | $590 |
| Blue Cross | Anthem Vivity Non City Of La Other Commercial Plan | $633 |
| La Care Health Plan | Covered Ca Exchange | $698 |
| Healthnet | Ambetter Hmo | $993 |
| Healthnet | Ambetter Ppo | $1,148 |
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All common services at Providence Little Co of Mary Med Center San Pedro