Emergency visit, high (level 4) at IU Health White Memorial Hospital. CPT 99284.
What IU Health White Memorial Hospital publishes for this service, straight from its standard-charges file, last updated March 25, 2026.
Outpatient / ER
$550cash price (self-pay)
$20,368list price
$296–$37,310range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Managed Health Services | All Government Medicaid | $296 |
| United Healthcare | All Managed Medicaid | $296 |
| Elevance Health | All Managed Medicaid | $296 |
| Managed Health Services | All Government Medicaid HIP | $296 |
| Elevance Health | All Government Medicaid HIP | $296 |
| Caresource | All Government Medicaid HIP | $296 |
| Caresource | All Managed Medicaid | $296 |
| Encore Health Network | PPO/HMO/EPO - Combined/Encircle | $1,303 |
| Encore Health Network | PPO | $7,536 |
| SIHO Insurance Services | PPO - Union Health | $8,351 |
| Elevance Health | All HMO/POS | $9,606 |
| Elevance Health | All PPO | $10,343 |
| Indiana Health Network (IHN) | All Managed Care | $10,600 |
| Suburban Health Organization | PPO - Direct | $10,693 |
| Aetna | HMO - Coventry Plans | $10,897 |
| Aetna | PPO/POS | $10,897 |
| Aetna | POS - Cox Medical Plans | $10,958 |
| Aetna | PPO - IN Preferred | $10,958 |
| Aetna | PPO - First Health | $11,813 |
| Deaconess Health System | All Managed Care | $11,813 |
| Aetna | PPO - NAP | $11,813 |
| Community Health Direct | HMO - LaPorte Regional Plans | $12,017 |
| Parkview Health | HMO - Employee Plans | $12,587 |
| Unified Group Services | HMO | $12,628 |
| Cigna | HMO - Open Access | $12,832 |
| Cigna | HMO | $12,832 |
| Sagamore Health Network/Cigna | PPO - DRG Plans | $12,832 |
| Sagamore Health Network/Cigna | PPO - NON-DRG | $12,832 |
| Cigna | PPO | $12,832 |
| Elevance Health | All Traditional Plans | $14,036 |
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