Emergency visit, high (level 4) at Mercy Hospital Fort Smith. CPT 99284.
What Mercy Hospital Fort Smith publishes for this service, straight from its standard-charges file, last updated June 8, 2026.
Outpatient / ER
$1,355cash price (self-pay)
$2,085list price
$12.00–$1,772range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Summit Community Care Contracted [320368] | Hb Ftsm Summit | $51.00 |
| Summit Community Care [20368] | Hb Ftsm Ark Medicaid | $51.00 |
| Medicaid [20240] | Hb Ftsm Ark Medicaid | $51.00 |
| Arkansas Department Of Health [20036] | Hb Ftsm Ark Medicaid | $51.00 |
| Caresource Medicaid Contracted [320460] | Hb Ftsm Caresource Medicaid | $52.02 |
| Caresource Medicaid [20460] | Hb Ftsm Caresource Medicaid | $52.02 |
| Empower Healthcare Solutions Medicaid [20118] | Hb Ftsm Passe Empower | $64.77 |
| Empower Healthcare Solutions Medicaid Contracted [320118] | Hb Ftsm Pa | $64.77 |
| Arkansas Total Care [20039] | Hb Ftsm Passe Ar Total Care | $116 |
| Arkansas Total Care Contracted [320039] | Hb Ftsm Passe Ar Total Care | $116 |
| Home State Medicaid Contracted [320189] | Hb Ftsm Managed Mo Mcd | $363 |
| Humana Medicaid Contracted [320486] | Hb Ftsm Ok Managed Medicaid | $379 |
| Oklahoma Complete Health Medicaid Contracted [320485] | Hb Ftsm Ok Man | $379 |
| Medicaid [20240] | Hb Ftsm Ok Medicaid | $379 |
| Aetna Medicaid Contracted [320009] | Hb Ftsm Ok Managed Medicaid | $379 |
| Longevity Health Plan Medicare Contracted [320225] | Hb Ftsm Managed M | $396 |
| Humana Medicare Advantage Contracted [320194] | Hb Ftsm Humana Mcr | $396 |
| Globalhealth Contracted [320145] | Hb Ftsm Managed Medicare | $396 |
| Health Choice Contracted [320166] | Hb Ftsm Oklahoma State And Educati | $533 |
| Home State Health Plan Contracted [320187] | Hb Ftsm Novasys Ambetter | $566 |
| Blue Cross And Blue Shield [20053] | Hb Ftsm BCBS Exchange | $650 |
| Mercy Benefit Admin Contracted [320251] | Hb Ftsm Dec Bartel | $733 |
| Mercy Benefit Admin Contracted [320251] | Hb Ftsm Dec Tall Tree | $733 |
| Mercy Benefit Admin Contracted [320251] | Hb Ftsm Dec Schaefer Qcg | $733 |
| Edison Health Solutions Contracted [320502] | Hb Ftsm Dec Woodard | $733 |
| Aither Health Contracted [320449] | Hb Ftsm Dec Woodard | $733 |
| Aither Health Contracted [320449] | Hb Ftsm Dec Laclede - New 07.01.25 | $733 |
| Yuzu Health Contracted [320521] | Hb Ftsm Dec Level Health - New 01.01 | $733 |
| Aetna Contracted [320008] | Hb Ftsm Coventry/Aetna | $854 |
| Aetna [20008] | Hb Ftsm Coventry/Aetna | $854 |
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