Emergency visit, high (level 4) at Saint Alphonsus Medical Center-Ontario. CPT 99284.
What Saint Alphonsus Medical Center-Ontario publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$268cash price (self-pay)
$3,867list price
$83.69–$6,457range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna Medicare Advantage | Aetna Medicare Advantage | $501 |
| American Health Advantage Of Idaho | American Health Medicare Advantag | $506 |
| Family Health Network | Medicaid | $607 |
| Medicaid - Ct | Medicaid | $607 |
| Blue Cross - De (Highmark) Medicaid Advantage | Medicaid | $607 |
| Simply Healthcare Medicaid | Medicaid | $607 |
| Medicaid - Ar | Medicaid | $607 |
| Medicaid - FL | Medicaid | $607 |
| Aetna Medicaid | Medicaid | $607 |
| Medicaid - Ga | Medicaid | $607 |
| Medicaid - Hi | Medicaid | $607 |
| Molina Medicaid | Medicaid | $607 |
| Meridian Medicaid | Medicaid | $607 |
| Medicaid - Dc | Medicaid | $607 |
| Trilogy Medicaid | Medicaid | $607 |
| Medicaid - In | Medicaid | $607 |
| Emblem Health Medicaid | Medicaid | $607 |
| Upper Peninsula Health Plan (Uphp) Medicaid | Medicaid | $607 |
| Medicaid - De | Medicaid | $607 |
| Medicaid - Ks | Medicaid | $607 |
| Medicaid - Ia | Medicaid | $607 |
| Cigna Medicaid Advantage | Medicaid | $607 |
| Medicaid - IL | Medicaid | $607 |
| Superior Health | Medicaid | $607 |
| Parkland Community Health Plan | Medicaid | $607 |
| Childrens Medical Services Title 19 | Medicaid | $607 |
| Independent Care Medicaid | Medicaid | $607 |
| Childrens Medical Center Health Plan Managed Medicaid | Medicaid | $607 |
| Wellsense Health Plan | Medicaid | $607 |
| Freedom First Healthcare | Medicaid | $607 |
Inpatient
$267cash price (self-pay)
$267list price
$75.40–$267range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Managed Health Services - Indiana | Medicaid | $93.35 |
| Nebraska Total Care | Medicaid | $93.35 |
| Mercycare Medicaid | Medicaid | $93.35 |
| Unity Medicaid | Medicaid | $93.35 |
| Amerihealth Caritas Medicaid | Medicaid | $93.35 |
| Upper Peninsula Health Plan (Uphp) Medicaid | Medicaid | $93.35 |
| Dean Wi Badgercare | Medicaid | $93.35 |
| Ghc Scw Wi Badgercare | Medicaid | $93.35 |
| Care Wisconsin Medicaid | Medicaid | $93.35 |
| Rx Allwin | Medicare | $112 |
| Unicare Medicare Advantage | Medicare | $112 |
| Align Senior Care | Medicare | $112 |
| Life St Marys Pace | Medicare | $112 |
| Aurora Special Needs | Medicare | $112 |
| Um Health Advantage | Medicare | $112 |
| Wellpoint Medicare Advantage | Medicare | $112 |
| Blue Cross - In (Anthem) Medicare Advantage | Medicare | $112 |
| Care Improvement Plus | Medicare | $112 |
| Wellmed | Medicare | $112 |
| Connecticare Vip Medicare Advantage | Medicare | $112 |
| Kaiser Permanente Medicare Advantage | Medicare | $112 |
| Us Family Health Plan | Tricare | $113 |
| Tricare | Tricare | $113 |
| Blue Cross - Ms | Regence BCBS | $222 |
| Blue Cross - Mt | Regence BCBS | $222 |
| Blue Cross - NY (Excellus) | Regence BCBS | $222 |
| Blue Shield - NY Highmark Western | Regence BCBS | $222 |
| Blue Shield - NY Highmark Northeastern | Regence BCBS | $222 |
| Blue Cross - Nc | Regence BCBS | $222 |
| Blue Cross - Ok | Regence BCBS | $222 |
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All common services at Saint Alphonsus Medical Center-Ontario