Emergency visit, high (level 4) at Medical City Fort Worth Hospital. CPT 99284.
What Medical City Fort Worth Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$5,278cash price (self-pay)
$5,278list price
$77.04–$5,887range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Molina | CHIP | $320 |
| Molina | MCDSTAR | $320 |
| Molina | STAR+PLUS | $320 |
| Molina | STARKIDS | $320 |
| Amerigroup | CHIP | $363 |
| Amerigroup | MGMCD | $363 |
| Cigna Healthspring | MGMCD | $700 |
| Cigna | IFP | $713 |
| Cigna | QHP | $739 |
| United | NarrowNetworkIndivExchange | $1,545 |
| Healthcare Highways | CityofPlano | $1,784 |
| United | SmallGroup | $1,937 |
| BCBS | Traditional | $2,185 |
| City of McKinney | COMM | $2,375 |
| Aetna | ASA | $2,666 |
| BCBS | BlueAdvantageHMO | $2,900 |
| BCBS | MyBlueHealth | $2,900 |
| Aetna | WCOMP | $2,903 |
| United | AllPayerAppendix | $2,931 |
| Aetna Coventry First Health | EXCLUSIVE | $3,024 |
| Aetna Coventry First Health | NONEXCLUSIVE | $3,024 |
| Averde Health, Inc | PPO | $3,061 |
| Emerging Therapy Solutions | Commercial | $3,536 |
| Healthcare Highways | NarrowNetwork | $3,542 |
| Evry Health | COMM | $3,626 |
| Coastal Comp Health Networks | WCOMP | $3,695 |
| HealthSmart Preferred Care | PPO | $3,748 |
| Lewisville Isd/Dls Consulting | Commppo | $3,959 |
| BCBS | BlueEssentials | $4,020 |
| BCBS | BlueEssentialsAccess | $4,020 |
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