Emergency visit, high (level 4) at San Gabriel Valley Medical Center. CPT 99284.
What San Gabriel Valley Medical Center publishes for this service, straight from its standard-charges file, last updated July 1, 2026.
Outpatient / ER
$444cash price (self-pay)
$2,435list price
$29.41–$6,872range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Healthy Way LA | Healthy Way LA | $29.41 |
| AHMC Medi-Cal Reciprocity | AHMC Medi-Cal Reciprocity | $68.35 |
| Allied Physicians | Allied Physicians Medi-Cal | $68.35 |
| AltaMed Health Network | AltaMed Health Network Medi-Cal | $68.35 |
| Beverly Hospital | BEVERLY HOSPITAL MCL | $68.35 |
| Emanate Health | Emanate Health Medi-Cal | $68.35 |
| HealthNet Medi-Cal Non-Contract | Health Net Medi-Cal | $68.35 |
| LA Care Health Plan | LA Care Healthy Kids and Medi-Cal Managed Care | $78.60 |
| Blue Cross Medi-Cal Managed Care | Blue Cross Medi-Cal | $78.86 |
| Care 1st Health Plan | BLUE SHIELD PROMISE HEALTH PLAN MCAL | $95.69 |
| AIDS Healthcare Foundation | AIDS Hlth Fndn/Positive Hlth Mcal | $98.04 |
| Avanti | Avanti Medi-cal | $98.04 |
| Hollywood Presbyterian Adv Med Mcal | Hollywood Presbyterian Adv Med M | $98.04 |
| Hollywood Presbyterian Medpoint Mcal | Hollywood Presbyterian Medpoint | $98.04 |
| Blue Cross Medi-Cal Managed Care | Blue Cross Healthy Families | $108 |
| United Healthcare Senior Medicare Advantage | United Healthcare Senior | $322 |
| Health Net | Health Net Healthy Families/Kids/AIM | $541 |
| Care 1st Health Plan | Care 1st Health Plan Healthy Families | $609 |
| AHMC Reciprocity | AHMC Reciprocity Commercial | $731 |
| AHMC Reciprocity | AHMC Reciprocity Sr | $731 |
| Central Health Plan | Central Health Plan HMO | $800 |
| Alignment Healthplan | Alignment Healthplan Allied Pacific Sr Cap | $852 |
| Brand New Day | Brand New Day Allied Pacific SR Cap | $852 |
| Clever Care | Clever Care Accountable Phys Cap | $852 |
| Clever Care | Clever Care Allied Phys Cap | $852 |
| AIDS Healthcare Foundation | AIDS Healthcare Foundation | $974 |
| Facey Medical | Facey Medical | $1,218 |
| Health Net | Health Net Enhanced PPO | $1,281 |
| Care 1st Health Plan | BLUE SHIELD PROMISE HEALTH HMO | $1,583 |
| Care 1st Health Plan | BLUE SHIELD PROMISE HEALTH SENIOR | $1,583 |
Inpatient
$444cash price (self-pay)
$2,435list price
$1,185–$2,435range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Beech Street | Beech Street PPO | $1,948 |
| MultiPlan | MultiPlan PPO | $2,192 |
| PPO Next | PPO Next | $2,192 |
| Other Non Contracted Commercial | Other Non Contracted Commercial | $2,435 |
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