Emergency visit, high (level 4) at UnityPoint Health - Iowa Lutheran Hospital. CPT 99284.
What UnityPoint Health - Iowa Lutheran Hospital publishes for this service, straight from its standard-charges file, last updated January 28, 2026.
Outpatient / ER
$44.00cash price (self-pay)
$276list price
$18.32–$1,053range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Wellmark Blue Cross and Blue Shield | PPO | $198 |
| Wellmark Blue Cross and Blue Shield | HMO | $198 |
| Wellmark UPH Self-Funded | Commercial | $198 |
| Cigna/Midlands | Commercial | $233 |
| Aetna | Medicare Advantage | $405 |
| Wellmark Blue Cross and Blue Shield | Medicare Advantage | $405 |
| Molina | Medicare Advantage | $405 |
| Iowa Total Care | Managed Medicaid | $410 |
| Amerigroup | Managed Medicaid | $410 |
| Medica Exchange Inspire | Commercial | $414 |
| United Healthcare | Medicare Advantage | $417 |
| Humana | Medicare Advantage | $417 |
| Amerivantage | Medicare Advantage | $417 |
| Medica Exchange Insure | Commercial | $464 |
| Health Partners Open Network | Commercial | $657 |
| Aetna | HMO | $855 |
| Aetna | PPO | $979 |
| United Healthcare | HMO | $1,036 |
| United Healthcare | PPO | $1,036 |
Inpatient
$44.00cash price (self-pay)
$1,243list price
$23.82–$1,053range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Cigna/Midlands | Commercial | $538 |
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All common services at UnityPoint Health - Iowa Lutheran Hospital