Emergency visit, high (level 4) at San Dimas Community Hospital. CPT 99284.
What San Dimas Community Hospital 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 |
|---|---|
| AIDS Healthcare Foundation | Aids Health Care Foundation Medi-cal | $98.04 |
| Blue Shield of Promise | Blue Shield Of Promise Medi-Cal | $98.04 |
| Heritage Provider Network Inc | Heritage Provider Network Medi-Cal | $98.04 |
| LA Care Health Plan | L A Care Health Plan Medi-cal | $98.04 |
| Molina Healthcare | Molina Medi-Cal | $98.04 |
| Anthem Blue Cross | Anthem Blue Cross Medi-Cal | $103 |
| Health Net of CA | Health Net Of CA Medi-Cal | $105 |
| Blue Shield of CA | Blue Shield Of CA Exchange | $365 |
| AIDS Healthcare Foundation | Aids Health Care Foundation MSSP | $534 |
| Anthem Blue Cross | Anthem Blue Cross Medicare | $534 |
| Blue Shield of CA | Blue Sheild Of CA Medicare | $534 |
| Blue Shield of CA | Blue Shield Of CA Triwest | $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 |
| Health Excel Inc | Health Excel Inc Medicare | $534 |
| Health Net of CA | Health Net Federal Services Tricare | $534 |
| Health Net of CA | Health Net Of CA Cal Mediconnect | $534 |
| Health Net of CA | Health Net Of CA Medicare | $534 |
| Heritage Provider Network Inc | Heritage Provider Network Medicare | $534 |
| LA Care Health Plan | LA Care Health Plan Covered CA and Covered Direc | $534 |
| LA Care Health Plan | LA Care Health Plan Duals Cal MediConnect | $534 |
| LA Care Health Plan | LA Care Health Plan Medicare | $534 |
| Molina Healthcare | Molina Exchange | $534 |
| Molina Healthcare | Molina Medicare | $534 |
| Brand New Day | Brand New Day Medicare | $539 |
| AIDS Healthcare Foundation | Aids Health Care Foundation Medicare | $545 |
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