Emergency visit, high (level 4) at MercyOne New Hampton Medical Center. CPT 99284.
What MercyOne New Hampton Medical Center publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$40.48cash price (self-pay)
$253list price
$1.92–$1,280range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna Medicare Advantage | Aetna Medicare Advantage | $110 |
| Iowa Total Care | Iowa Total Care Medicaid | $316 |
| Wellpoint Medicare Advantage | Wellpoint Medicare Advantage | $319 |
| Medical Associates | Medical Associates | $415 |
| Molina Medicaid | Molina Medicaid | $444 |
| Wellpoint Medicaid | Wellpoint Medicaid | $446 |
| Oscar | Oscar | $477 |
| Blue Cross - Ia (Wellmark) Medicare Advantage | Wellmark Medicare Adva | $507 |
| Health Partners Medicare Advantage | Unitypoint Health Partners Medica | $517 |
| Medicare Medical Associates Health Plans | Medical Associates Medicare | $539 |
| United Healthcare Medicare | United Healthcare Medicare Advantage | $543 |
| Geha | United Healthcare | $569 |
| United Healthcare | United Healthcare | $569 |
| Medigold Medicare Advantage | Mercyone Health Plan Medicare Advantage | $572 |
| Claimdoc | Claimdoc | $629 |
| Health Choices | Medical Associates | $646 |
| Aetna Domestic | Aetna | $739 |
| Meritain | Aetna | $739 |
| Aetna | Aetna | $739 |
| Nova | Claimdoc | $1,029 |
| Trustmark Small Business Benefits | Aetna | $1,210 |
| Medical Mutual | Aetna | $1,210 |
| First Health | Aetna | $1,210 |
| 1199 National Benefit Fund | Aetna | $1,210 |
| Lucent Health | Aetna | $1,210 |
| Aetna Eap | Aetna | $1,210 |
| Allied Benefit Systems | Aetna | $1,210 |
| Coventry | Aetna | $1,210 |
| Luminare Health | Aetna | $1,210 |
| Asr Health Benefits | Aetna | $1,210 |
Inpatient
$284cash price (self-pay)
$284list price
$75.40–$284range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Wellpoint | Wellpoint Medicaid Advantage | $93.76 |
| Rx Allwin | Medicare | $108 |
| Triwest Health Alliance | Tricare | $110 |
| Optum Health | Ubh Optum | $115 |
| Amish Hospital Aid | Amish Medical Aid | $146 |
| Avera | Avera Health Plan | $166 |
| Blue Cross - Co (Anthem) | Wellmark BCBS | $198 |
| Blue Shield - CA | Wellmark BCBS | $198 |
| Blue Cross - De (Highmark) | Wellmark BCBS | $198 |
| Blue Shield - NY Highmark Western | Wellmark BCBS | $198 |
| Kaiser Domestic | Wellmark BCBS | $198 |
| Health Smart | Healthsmart | $203 |
| Quiktrip | Quiktrip | $214 |
| The Alliance | The Alliance | $231 |
| Centivo | Centivo | $245 |
| United Healthcare | United Healthcare | $253 |
| Geha | United Healthcare | $253 |
| Velocity | Velocity | $258 |
| Wc Aims | Workers Comp | $284 |
| Wc Am Trust N America | Workers Comp | $284 |
| Wc Alaska National Ins | Workers Comp | $284 |
| Wc California State Ins Fund | Workers Comp | $284 |
| Wc California State Comp Ins | Workers Comp | $284 |
| Wc Kemberton | Workers Comp | $284 |
| Wc West Bend Mutual/Argent | Workers Comp | $284 |
| Wc Peerless | Workers Comp | $284 |
| Wc Mac Risk Management | Workers Comp | $284 |
| Wc First Agency/Occunet | Workers Comp | $284 |
| Wc Ct Healthcare Trust | Workers Comp | $284 |
| Wc Cirma | Workers Comp | $284 |
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