Emergency visit, high (level 4) at Saint Clares Dover Hospital. CPT 99284.
What Saint Clares Dover Hospital publishes for this service, straight from its standard-charges file, last updated September 10, 2026.
Outpatient / ER
$483cash price (self-pay)
$2,127list price
$140–$1,702range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Horizon | Horizon NJ Health - Medicaid | $140 |
| UHC | UHC Medicaid | $140 |
| Wellpoint Amerigroup | Wellpoint Amerigroup Medicaid (05-03-2023 to 12 | $140 |
| Humana | HUMANA MILITARY TRICARE | $387 |
| Aetna | Aetna Medicare | $484 |
| Amerihealth | Amerihealth HMO Medicare | $484 |
| Clover Health | Clover Medicare | $484 |
| Horizon | Horizon Medicare | $484 |
| Traditional Medicare | Traditional Medicare | $484 |
| Tricare | Tricare | $484 |
| UHC | UHC Medicare | $484 |
| Wellcare | Wellcare Medicare | $484 |
| Wellpoint Amerigroup | Wellpoint Amerigroup Medicare | $484 |
| ALLY-ALIGN (fka Spartan Health Plan) | ALLY-ALIGN (fka Spartan Health | $508 |
| Wellcare | Wellcare Insurance Exchange (01-01-2022 to 12-31-2026) | $653 |
| Employer Direct Healthcare | Employer Direct Healthcare | $677 |
| Cigna | Cigna Commercial | $748 |
| Fairprice Healthcare Holdings - Fphh | Fairprice Healthcare Holdings - | $774 |
| UHC | UHC Commercial Oxford | $908 |
| UHC - Adhoc | UHC - Adhoc Oxford | $936 |
| Coventry | Coventry Auto | $968 |
| Coventry | Coventry workers comp | $968 |
| Horizon | Horizon BCBS of NJ HMO POS | $1,006 |
| Horizon | Horizon BCBS of NJ Indemnity | $1,006 |
| Horizon | Horizon BCBS of NJ PPO | $1,006 |
| Aetna | Aetna Commercial | $1,026 |
| Aetna | Aetna Medical Rental Network | $1,026 |
| UHC | UHC Commercial All Payers | $1,037 |
| UHC - Adhoc | UHC - Adhoc All Payer | $1,100 |
| Horizon | HORIZON CASUALTY SERVICES Workers Comp | $1,127 |
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