Emergency visit, high (level 4) at Intermountain Health Orem Community Hospital. CPT 99284.
What Intermountain Health Orem Community Hospital publishes for this service, straight from its standard-charges file, last updated August 5, 2026.
Outpatient / ER
$2,074cash price (self-pay)
$2,766list price
$119–$3,831range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| TriWest | Veterans Choice | $408 |
| Health Plan of Nevada | Medicaid | $422 |
| SelectHealth | Medicaid | $422 |
| Aetna | Medicare Adv HMO | $422 |
| Health Partners of Nevada | Medicare Advantage | $422 |
| Healthy U | Medicaid | $422 |
| Humana | Medicare Choice PPO | $422 |
| Molina | Medicaid | $422 |
| SelectHealth | Medicare Advantage | $422 |
| UHC | Medicare Advantage | $422 |
| American Health | Medicare Adv UT HMO I-SNP | $439 |
| Regence BCBS | MedAdvantage PPO | $439 |
| SelectHealth | Signature Individual ACA | $441 |
| SelectHealth | Value Individual ACA | $441 |
| Aetna | Medicare Adv PPO | $465 |
| Molina | Medicare Advantage | $465 |
| Molina | Medicare Choice Care HMO | $465 |
| Molina | Medicare Complete Care HMO SNP | $465 |
| SelectHealth | Med Individual ACA | $483 |
| Deseret Mutual | All Other | $1,590 |
| Deseret Mutual | Select | $1,590 |
| Cigna | Open Access Flex | $1,742 |
| AWH Connected | Connected Utah | $1,784 |
| AG Administrators | USU Athletics | $1,991 |
| BYU Athletics | Commercial | $1,991 |
| Campbell Scientific | Commercial | $1,991 |
| CorVel Corporation | Workers Comp | $1,991 |
| BYU Risk Management | Workers Comp | $2,019 |
| Corporation of the President | Workers Comp | $2,019 |
| Aetna | Connected | $2,240 |
Inpatient
$2,074cash price (self-pay)
$2,766list price
$66.38–$2,627range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Donor Connect | Other | $66.38 |
| Health Plan of Nevada | Medicaid | $830 |
| Intermountain Caregiver Plan | Share Network | $1,173 |
| Intermountain Caregiver Plan | Med Network | $1,333 |
| SelectHealth | CHP | $1,333 |
| SelectHealth | Commercial | $1,333 |
| EMI | Commercial | $1,494 |
| Deseret Mutual | All Other | $1,590 |
| Deseret Mutual | Select | $1,590 |
| Regence BCBS | BlueOption | $1,708 |
| Cigna | Open Access Flex | $1,742 |
| AWH Connected | Connected Utah | $1,756 |
| EMI Health | Mint | $1,919 |
| EMI Health | Network Care | $1,919 |
| PEHP | Advantage State | $1,925 |
| BYU Risk Management | Workers Comp | $1,936 |
| Corporation of the President | Workers Comp | $1,936 |
| Regence BCBS | High Performance | $1,936 |
| Regence BCBS | FEHBP | $1,950 |
| PEHP | Advantage Non-State | $1,964 |
| AG Administrators | USU Athletics | $1,991 |
| BYU Athletics | Commercial | $1,991 |
| Campbell Scientific | Commercial | $1,991 |
| CorVel Corporation | Workers Comp | $1,991 |
| Franklin County | Commercial | $1,991 |
| Juniper Systems | Commercial | $1,991 |
| LW Miller | Commercial | $1,991 |
| Injury Care of Nevada | Workers Comp | $2,074 |
| Regence BCBS | Traditional | $2,102 |
| Managed Care Admin | Commercial | $2,157 |
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All common services at Intermountain Health Orem Community Hospital