Emergency visit, high (level 4) at Dodge County Hospital Authority. CPT 99284.
What Dodge County Hospital Authority publishes for this service, straight from its standard-charges file, last updated May 14, 2026.
Outpatient / ER
—cash price (self-pay)
$1,017list price
$139–$1,620range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Peach State Medicaid | HMO | $158 |
| Amerigroup Medicaid | PPO | $167 |
| Aetna Medicare Advantage | HMO | $364 |
| UHC Medicare Advantage | HMO | $364 |
| Humana Medicare PPO | PPO | $364 |
| BCBS PPO/Par | PPO | $697 |
| BCBS Pathway/HMO | HMO | $754 |
| Aetna | PPO | $763 |
| Cigna | PPO | $915 |
| UHC Commercial | PPO | $1,620 |
Inpatient
—cash price (self-pay)
$1,017list price
$1.00–$606range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Cigna | PPO | $1.00 |
| UHC Commercial | PPO | $1.00 |
| Peach State Medicaid | HMO | $1.00 |
| BCBS PPO/Par | PPO | $422 |
| Amerigroup Medicaid | PPO | $543 |
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