Emergency visit, high (level 4) at Health Alliance Mary Avenue Hospital. CPT 99284.
What Health Alliance Mary Avenue Hospital publishes for this service, straight from its standard-charges file, last updated June 24, 2026.
Outpatient / ER
$443cash price (self-pay)
$3,392list price
$253–$35,000range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Veterans (Mcr) | Veterans (Mcr) | $363 |
| Aetna Medicare | Aetna Medicare | $518 |
| Beacon Medicare | Beacon Medicare | $518 |
| Blue Cross Medicare | Blue Cross Medicare | $518 |
| Cdphp Medicare | Cdphp Medicare | $518 |
| Hamaspik (Mcr) | Hamaspik (Mcr) | $518 |
| Medicare Managed 100% Hahv | Medicare Managed 100 Hahv | $518 |
| Mvp Gold (Mcr) | Mvp Gold (Mcr) | $518 |
| Todays Options Medicare | Todays Options Medicare | $518 |
| Medicare | Medicare | $521 |
| Emblem Ghi/Hip Medicare | Emblem Ghi/Hip Medicare | $529 |
| Affinity By Molina Mcr | Affinity By Molina Mcr | $544 |
| Todays Options | Todays Options | $570 |
| Beacon Exchange | Beacon Exchange | $622 |
| Beacon Commercial | Beacon Commercial | $674 |
| Value Options Comm (Chcs) | Value Options Comm (Chcs) | $765 |
| VALUE OPTIONS (Non-HMO) | VALUE OPTIONS (Non-HMO) | $777 |
| Mvp Exchange | Mvp Exchange | $1,344 |
| UHC Exchange | UHC Exchange | $1,425 |
| Cdphp | Cdphp | $1,463 |
| Oxford Exchange | Oxford Exchange | $1,508 |
| Blue Cross Connection/Exchange | Blue Cross Connection/Exchange | $1,568 |
| Mvp HMO/PPO | Mvp HMO/PPO | $1,581 |
| Blue Cross Access | Blue Cross Access | $1,673 |
| UHC Commercial | UHC Commercial | $1,676 |
| UHC Empire | UHC Empire | $1,676 |
| Blue Cross Small Group | Blue Cross Small Group | $1,882 |
| Emblem Ghi/Hip PPO/Cbp | Emblem Ghi/Hip PPO/Cbp | $1,882 |
| Aetna Hp Network | Aetna Hp Network | $1,962 |
| Emblem Select Care (Exchange) | Emblem Select Care (Exchange) | $1,969 |
Inpatient
$443cash price (self-pay)
$3,392list price
$310–$7,052range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Magnacare Standard | Magnacare Standard | $2,374 |
| Multiplan | Multiplan | $2,781 |
| Blue Shield - Health Now | Blue Shield - Health Now | $3,222 |
| Medigap | Medigap | $3,392 |
| NON CONTRACTED (100% POC) | NON CONTRACTED (100 PerCent POC) | $3,392 |
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