Emergency visit, high (level 4) at Holy Cross Hospital - Davis. CPT 99284.
What Holy Cross Hospital - Davis publishes for this service, straight from its standard-charges file, last updated February 11, 2026.
Outpatient / ER
$747cash price (self-pay)
$1,868list price
$97.36–$1,868range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Managed Medicaid | Managed Medicaid | $97.36 |
| UUHP | Managed Medicaid | $97.36 |
| Humana | Managed Medicare | $112 |
| Managed Medicare | Managed Medicare | $112 |
| Medicare | Medicare | $112 |
| Employer Direct Healthcare | Commercial PPO/POS/HMO | $141 |
| MotivHealth | Commercial PPO/POS/HMO | $149 |
| PEHP | Commercial Summit Exclusive | $164 |
| Select Health | Commercial PPO/POS/HMO | $179 |
| Molina | Commercial PPO/POS/HMO | $237 |
| Centura Employee Plan | Commercial PPO/POS/HMO/EPO | $374 |
| Regence Blue Cross Blue Shield | Commercial PAR | $422 |
| Regence Blue Cross Blue Shield | Commercial PPO | $422 |
| Regence Blue Cross Blue Shield | Commercial Savewell | $422 |
| Regence Blue Cross Blue Shield | Commercial UVU | $422 |
| PEHP | Commercial Capital Network | $798 |
| Aetna | Commercial Peak Performance | $825 |
| UUHP | Commercial Health Plus | $921 |
| UUHP | Commercial Healthy Preferred | $921 |
| PEHP | Commercial Summit | $951 |
| Wise | Commercial PPO | $971 |
| Aetna | Commercial Standard Network | $984 |
| UUHP | Commercial Healthy Premier | $1,012 |
| Regence Blue Cross Blue Shield | Commercial Blue Option | $1,037 |
| PEHP | Commercial Advantage | $1,083 |
| Deseret Mutual Benefit Administrators | Commercial PPO/POS/HMO | $1,147 |
| Multiplan | Commercial Primary | $1,289 |
| United Healthcare | Commercial PPO/POS/HMO | $1,354 |
| Aetna | Commercial Signature | $1,358 |
| Aetna | Commercial Extended Network | $1,401 |
Inpatient
$747cash price (self-pay)
$1,868list price
$695–$1,868range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Regence Blue Cross Blue Shield | Commercial Savewell | $695 |
| PEHP | Commercial Capital Network | $798 |
| Molina | Commercial PPO/POS/HMO | $802 |
| Aetna | Commercial Peak Performance | $825 |
| Regence Blue Cross Blue Shield | Commercial UVU | $856 |
| PEHP | Commercial Summit Exclusive | $883 |
| Select Health | Commercial PPO/POS/HMO | $918 |
| PEHP | Commercial Summit | $951 |
| Aetna | Commercial Standard Network | $984 |
| Wise | Commercial PPO | $990 |
| Regence Blue Cross Blue Shield | Commercial PPO | $1,007 |
| PEHP | Commercial Advantage | $1,083 |
| Regence Blue Cross Blue Shield | Commercial Blue Option | $1,121 |
| Regence Blue Cross Blue Shield | Commercial PAR | $1,121 |
| Deseret Mutual Benefit Administrators | Commercial PPO/POS/HMO | $1,147 |
| Multiplan | Commercial Primary | $1,289 |
| Aetna | Commercial Signature | $1,358 |
| Aetna | Commercial Extended Network | $1,401 |
| Aetna | Commercial Indemnity | $1,494 |
| Aetna Rental Networks | Commercial PPO/POS/HMO | $1,578 |
| EMI Health | Commercial PPO/POS/HMO | $1,625 |
| Multiplan | Commercial Complementary | $1,700 |
| United Healthcare | Commercial Behavioral Health | $1,868 |
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