Emergency visit, high (level 4) at Forks Community Hospital. CPT 99284.
What Forks Community Hospital publishes for this service, straight from its standard-charges file, last updated July 9, 2026.
Outpatient / ER
$1,253cash price (self-pay)
$1,566list price
$68.22–$2,276range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Regence Medicaid | Regence Medicaid | $68.22 |
| Coordinated Care (Mco) Mcd-All Plans | Coordinated Care (Mco) Mcd-All | $68.22 |
| Molina Medicaid | Molina Medicaid | $68.22 |
| UHC Medicaid | UHC Medicaid | $68.22 |
| Amerigroup Medicaid-All Plans | Amerigroup Medicaid-All Plans | $72.31 |
| UHC Mcr Adv | UHC Mcr Adv | $112 |
| Humana Mcr Adv - All Plans | Humana Mcr Adv - All Plans | $117 |
| Molina Commercial-All Other Plans | Molina Commercial-All Other Plans | $117 |
| Triwest-All Plans | Triwest-All Plans | $117 |
| Va-Ihs - All Plans | Va-Ihs - All Plans | $117 |
| Tricare-All Plans | Tricare-All Plans | $119 |
| Community Health Network Mcr-All Other Plans | Community Health Networ | $135 |
| Molina Medicare | Molina Medicare | $135 |
| Ambetter Ccwa Exch - All Plans | Ambetter Ccwa Exch - All Plans | $136 |
| Wellcare Med Adv - All Plans | Wellcare Med Adv - All Plans | $136 |
| Community Health Exchange | Community Health Exchange | $159 |
| First Choice-All Plans | First Choice-All Plans | $161 |
| UHC All Payer/Doctors Plan/Nexus-All Other Plans | UHC All Payer/Docto | $163 |
| Premera Blue Cross-All Plans | Premera Blue Cross-All Plans | $166 |
| Cigna-All Plans | Cigna-All Plans | $1,253 |
| Regence-All Other Plans | Regence-All Other Plans | $1,311 |
| Aetna-All Plans | Aetna-All Plans | $1,488 |
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