Emergency visit, high (level 4) at IU Health Jay Hospital. CPT 99284.
What IU Health Jay Hospital publishes for this service, straight from its standard-charges file, last updated March 25, 2026.
Outpatient / ER
$789cash price (self-pay)
$20,368list price
$296–$38,292range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Caresource | All Managed Medicaid | $296 |
| United Healthcare | All Managed Medicaid | $296 |
| Elevance Health | All Managed Medicaid | $296 |
| Managed Health Services | All Government Medicaid | $296 |
| Elevance Health | All Government Medicaid HIP | $296 |
| Managed Health Services | All Government Medicaid HIP | $296 |
| Caresource | All Government Medicaid HIP | $296 |
| Encore Health Network | PPO/HMO/EPO - Combined/Encircle | $1,303 |
| Elevance Health | All HMO/POS | $8,176 |
| Elevance Health | All PPO | $8,176 |
| Elevance Health | All Traditional Plans | $8,658 |
| Suburban Health Organization | PPO - Direct | $10,693 |
| Aetna | POS - Cox Medical Plans | $11,793 |
| Aetna | PPO - IN Preferred | $11,793 |
| Deaconess Health System | All Managed Care | $11,813 |
| Cigna | PPO - New Business | $11,813 |
| Community Health Direct | HMO - LaPorte Regional Plans | $12,017 |
| Parkview Health | HMO - Employee Plans | $12,587 |
| Unified Group Services | HMO | $12,628 |
| Lutheran Health Network | All Managed Care | $14,258 |
| United Healthcare | All Managed Care | $14,453 |
| Parkview Health | EPO | $14,685 |
| Aetna | PPO - First Health | $14,869 |
| Aetna | PPO - NAP | $14,869 |
| Aetna | HMO - Coventry Plans | $15,439 |
| Aetna | PPO/POS | $15,439 |
| Lutheran Preferred | All PPO Plans | $16,294 |
| Parkview Health | PPO | $16,783 |
| Encore Health Network | PPO | $17,741 |
| Indiana Health Network (IHN) | All Managed Care | $17,987 |
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