Emergency visit, high (level 4) at UnityPoint Health - St. Lukes Downtown. CPT 99284.
What UnityPoint Health - St. Lukes Downtown publishes for this service, straight from its standard-charges file, last updated January 28, 2026.
Outpatient / ER
$44.00cash price (self-pay)
$276list price
$14.30–$1,137range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Nebraska Total Care | Managed Medicaid | $71.76 |
| Avera Health Plan | Commercial | $165 |
| Wellmark UPH Self-Funded | Commercial | $198 |
| Wellmark Blue Cross and Blue Shield | PPO | $198 |
| Wellmark Blue Cross and Blue Shield | HMO | $198 |
| Medica Exchange Inspire | Commercial | $223 |
| Cigna/Midlands | Commercial | $233 |
| Medica Exchange Insure | Commercial | $250 |
| Amerigroup | Managed Medicaid | $377 |
| Iowa Total Care | Managed Medicaid | $377 |
| Aetna | Medicare Advantage | $423 |
| Wellmark Blue Cross and Blue Shield | Medicare Advantage | $423 |
| Molina | Medicare Advantage | $423 |
| Amerivantage | Medicare Advantage | $436 |
| Humana | Medicare Advantage | $436 |
| United Healthcare | Medicare Advantage | $436 |
| Health Partners Open Network | Commercial | $636 |
| Aetna | HMO | $907 |
| Aetna | PPO | $1,041 |
| United Healthcare | PPO | $1,137 |
| United Healthcare | HMO | $1,137 |
Inpatient
$44.00cash price (self-pay)
$433list price
$34.60–$510range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Cigna/Midlands | Commercial | $272 |
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All common services at UnityPoint Health - St. Lukes Downtown