Emergency visit, high (level 4) at Medicine Lodge Memorial Hospital. CPT 99284.
What Medicine Lodge Memorial Hospital publishes for this service, straight from its standard-charges file, last updated August 5, 2026.
Outpatient / ER
$200cash price (self-pay)
$973list price
$97.68–$973range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Tricare West-All Plans | Tricare West-All Plans | $400 |
| Humana Mcr Adv-All Plans | Humana Mcr Adv-All Plans | $452 |
| Aetna Mcr Adv | Aetna Mcr Adv | $463 |
| Sunflower Mcaid-All Plans | Sunflower Mcaid-All Plans | $536 |
| Aetna Better Health Mcaid Chip | Aetna Better Health Mcaid Chip | $536 |
| Hpk-All Plans | Hpk-All Plans | $557 |
| BCBS Blue Choice | BCBS Blue Choice | $660 |
| BCBS Cap - All Other Plans | BCBS Cap - All Other Plans | $695 |
| Aetna Comm-All Other Plans | Aetna Comm-All Other Plans | $900 |
| Aetna/First Health Network | Aetna/First Health Network | $924 |
| UHC-All Plans | UHC-All Plans | $924 |
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