Emergency visit, high (level 4) at Southeast Iowa Regional Medical Center West Burlington. CPT 99284.

What Southeast Iowa Regional Medical Center West Burlington publishes for this service, straight from its standard-charges file, last updated June 11, 2026.

Outpatient / ER

—cash price (self-pay)

$442list price

$77.37–$1,232range insurers pay

Insurance plan	Negotiated rate
Medicaid - Nurse Practitioner \| MANAGED MEDICAID	$77.37
Medicaid - Physician Assistant \| MANAGED MEDICAID	$79.02
United Behavioral Health MA \| MEDICARE ADV.	$84.82
United Behavioral Health RN \| MEDICARE ADV.	$84.82
Medicaid - Physician \| MANAGED MEDICAID	$91.03
American Healthplan of Iowa - Midlevel \| MEDICARE ADV.	$91.74
United Behavioral Health MA \| ALL PRODUCTS	$93.67
United Behavioral Health PHD \| MEDICARE ADV.	$96.13
United Behavioral Health PHD \| ALL PRODUCTS	$106
United Behavioral Health RN \| ALL PRODUCTS	$106
United Behavioral Health MD \| MEDICARE ADV.	$113
Humana \| MEDICARE ADV.	$114
American Healthplan of Iowa - MD \| MEDICARE ADV.	$121
United Behavioral Health MD \| ALL PRODUCTS	$125
Midlands Choice \| ALL PRODUCTS	$175
United Healthcare \| ALL PRODUCTS	$183
Wellmark Blue Cross - Anesthesiology \| PPO	$198
Wellmark Blue Cross - Pathologist \| PPO	$198
Elap \| Primary	$224
Aetna \| FIRST HEALTH	$252
Elap \| Specialty	$256
Immergrun \| ALL PRODUCTS	$269
Plain Church \| ALL PRODUCTS	$287
Elap \| Anesthesia	$319
6 Degree \| ALL PRODUCTS	$341
Absolute Solutions \| ALL PRODUCTS	$398
First Agency \| ALL PRODUCTS	$398
Multiplan \| ALL PRODUCTS	$398
Henderson County \| ALL PRODUCTS	$420
Wellpoint (Amerigroup) \| Managed Medicaid	$742

Inpatient

—cash price (self-pay)

$1,325list price

$742–$1,232range insurers pay

Insurance plan	Negotiated rate
Midlands Choice \| All Products	$1,193

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All common services at Southeast Iowa Regional Medical Center West Burlington