Emergency visit, high (level 4) at Mount Carmel Dublin Hospital. CPT 99284.
What Mount Carmel Dublin Hospital publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$40.48cash price (self-pay)
$253list price
$12.06–$4,096range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Union Health Service | Pb Xr 100% Default | $147 |
| Dentaquest | Pb Xr 100% Default | $147 |
| Commonwealth Care Alliance | Pb Xr 100% Default | $147 |
| Pace Of Southwest Michigan | Pb Xr 100% Default | $147 |
| Molina Medicare Advantage | Pb Xr 100% Default | $147 |
| The Health Plan | Pb Xr 100% Default | $147 |
| Rx Allwin | Pb Xr 100% Default | $147 |
| Everence | Pb Xr 100% Default | $147 |
| Harvard Pilgrim Healthcare | Pb Xr 100% Default | $147 |
| Health Choices | Pb Xr 100% Default | $147 |
| Medigold Medicare Advantage | Medigold Medicare Advantage | $354 |
| Aetna Medicare Advantage | Aetna Medicare Advantage | $394 |
| Blue Cross - Oh (Anthem) Medicare Advantage | Anthem BCBS Medicare Adv | $394 |
| Medical Mutual Medicare | Medical Mutual Medicare Advantage | $402 |
| Aetna Medicare Advantage | Aetna Better Health Medicare Advantage | $414 |
| Molina Medicare Advantage | Molina Medicare Advantage | $414 |
| Caresource Medicare | Caresource Medicare Advantage | $414 |
| Universal Medicare | Universal Medicare Advantage | $422 |
| Oscar | Oscar | $664 |
| Enterprise Group Planning | Enterprise Group Planning Medicare Adv | $777 |
| Custom Design Benefits | Custom Design Benefit | $841 |
| Quality Care Partners | Quality Care Partners | $909 |
| Medical Mutual | Medical Mutual Medflex | $989 |
| Blue Cross - Oh (Anthem) | Anthem BCBS Pathway Grp HMO | $1,248 |
| Western & Southern Financial Group | Medical Mutual Supermed PPO POS H | $1,363 |
| Medical Mutual | Medical Mutual Supermed PPO POS HMO | $1,363 |
| Aetna | Aetna Neighborhood Narrow Network | $2,414 |
| United Healthcare | United Healthcare Exchange | $2,478 |
| Aetna | Aetna | $3,430 |
| Aetna Domestic | Aetna | $3,430 |
Inpatient
$276cash price (self-pay)
$276list price
$75.40–$276range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Triwest Health Alliance | Tricare | $115 |
| Health Choices | Pb Xr 100% Default | $276 |
| Dentaquest | Pb Xr 100% Default | $276 |
| Molina Medicare Advantage | Pb Xr 100% Default | $276 |
| Pace Of Southwest Michigan | Pb Xr 100% Default | $276 |
| Harvard Pilgrim Healthcare | Pb Xr 100% Default | $276 |
| Union Health Service | Pb Xr 100% Default | $276 |
| Everence | Pb Xr 100% Default | $276 |
| Rx Allwin | Pb Xr 100% Default | $276 |
| Commonwealth Care Alliance | Pb Xr 100% Default | $276 |
| The Health Plan | Pb Xr 100% Default | $276 |
| Pacificsource Health Plans | Pb Xr 100% Default | $276 |
| Osu Not Independent Choice | Pb Xr 100% Default | $276 |
| Wc Alaska National Ins | Pb Xr 100% Default | $276 |
| Wc California State Ins Fund | Pb Xr 100% Default | $276 |
| Wc California State Comp Ins | Pb Xr 100% Default | $276 |
| Liability Other | Pb Xr 100% Default | $276 |
| Ovag International Claims | Pb Xr 100% Default | $276 |
| Ohio Safe Program | Pb Xr 100% Default | $276 |
| East Greenbush Central School District | Pb Xr 100% Default | $276 |
| St Mary Rehab Hospital Ll | Pb Xr 100% Default | $276 |
| Greene County Sheriff Dept | Pb Xr 100% Default | $276 |
| Ohio PPO Connect | Pb Xr 100% Default | $276 |
| Great Southern Life | Pb Xr 100% Default | $276 |
| North American Administrators | Pb Xr 100% Default | $276 |
| Jfp Benefit Management | Pb Xr 100% Default | $276 |
| Employee Benefit Concepts | Pb Xr 100% Default | $276 |
| Secura Insurance | Pb Xr 100% Default | $276 |
| Plumbers Local 98 Insurance Fund | Pb Xr 100% Default | $276 |
| Group Management Services | Pb Xr 100% Default | $276 |
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