Emergency visit, high (level 4) at Dupont Hospital. CPT 99284.
What Dupont Hospital publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$68.04cash price (self-pay)
$252list price
$61.08–$2,653range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Physicians Health Plan | PHP Options | $61.08 |
| Amish Aid | Amish Aid | $68.04 |
| Self Pay | Self Pay | $68.04 |
| Lutheran Preferred | Lutheran Preferred CHS Employees | $74.84 |
| Physicians Health Plan | PHP Classic Network | $80.29 |
| Cigna | Cigna HMO | $81.40 |
| PHP Freedom Network | PHP Freedom Network | $83.64 |
| Cigna | Cigna PPO | $91.48 |
| Aetna | Aetna NBD | $93.24 |
| Aetna PSSD J and J | Aetna PSSD JJ | $93.24 |
| Physicians Health Plan | PHP Platinum Network | $97.57 |
| Lutheran Preferred | Lutheran Preferred Three Rivers Plus | $101 |
| Veterans Eval Services | Veterans Eval Services | $110 |
| Aetna | Aetna | $113 |
| Lutheran Preferred | Lutheran Preferred Fixed | $113 |
| Lutheran Preferred | Lutheran Preferred Inclusive | $113 |
| Lutheran Preferred | Lutheran Preferred Three Rivers | $113 |
| Encore PPO | Encore Combined PPO | $126 |
| Lutheran Preferred | Lutheran Preferred Exclusive Plus | $126 |
| Lutheran Network | Lutheran Preferred Exclusive Plus MRM | $126 |
| Medical Mutual of OH | Medical Mutual of Ohio | $134 |
| Sagamore | Sagamore Select Fully Insured | $136 |
| Lutheran Preferred | Lutheran Preferred Choice | $139 |
| Lutheran Preferred | Lutheran Preferred Exclusive | $139 |
| Sagamore | Sagamore Plus | $140 |
| Sagamore | Sagamore Select Self Insured | $140 |
| Lutheran Preferred | Lutheran Preferred CCSI | $151 |
| Prime Health Services | Prime Health Services | $189 |
| Prime Health Services | Prime Health Services Auto | $189 |
| FrontPath | FrontPath Health Coalition | $202 |
Inpatient
$113cash price (self-pay)
$252list price
$74.84–$2,653range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Lutheran Preferred | Lutheran Preferred CHS Employees | $74.84 |
| Cigna | Cigna HMO | $81.40 |
| Cigna | Cigna PPO | $91.48 |
| Aetna | Aetna NBD | $93.24 |
| Aetna PSSD J and J | Aetna PSSD JJ | $93.24 |
| Physicians Health Plan | PHP Platinum Network | $97.57 |
| Aetna | Aetna | $113 |
| Self Pay | Self Pay | $113 |
| Medical Mutual of OH | Medical Mutual of Ohio | $134 |
| Lutheran Preferred | Lutheran Preferred Choice | $139 |
| Lutheran Preferred | Lutheran Preferred Exclusive | $139 |
| Lutheran Preferred | Lutheran Preferred CCSI | $151 |
| Prime Health Services | Prime Health Services | $189 |
| Prime Health Services | Prime Health Services Auto | $189 |
| FrontPath | FrontPath Health Coalition | $202 |
| Encore Health Network | Encore Fully Funded | $207 |
| Advantage Health Solutions | Advantage Health Solutions | $209 |
| Multiplan | Multiplan PPO Primary Network | $217 |
| Allied Benefit Systems | Allied Benefit Systems | $227 |
| Encore Health Network | Encore Self Funded | $227 |
| Multiplan | Multiplan PPO Complimentary Network | $227 |
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