Emergency visit, high (level 4) at Salem Memorial District Hospital. CPT 99284.
What Salem Memorial District Hospital publishes for this service, straight from its standard-charges file, last updated May 7, 2026.
Outpatient / ER
$256cash price (self-pay)
$1,266list price
$116–$1,228range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United Healthcare-MC Advantage | Medicare Advantage | $278 |
| Humana-MC Advantage | Medicare Advantage | $278 |
| Aetna-MC Advantage | Medicare Advantage | $278 |
| Tricare | Federal | $278 |
| BCBS-MC Advantage | Medicare Advantage | $278 |
| AmBetter | HMO/PPO/POS | $278 |
| Healthlink | HMO/PPO/POS | $531 |
| Cigna | HMO/PPO/POS | $604 |
| Mercy - ClayCo | HMO/PPO/POS | $653 |
| Mercy - Missouri State University | HMO/PPO/POS | $653 |
| Mercy - QuikTrip Corporation | HMO/PPO/POS | $653 |
| Mercy - C.B. Management Company/Joplin Supply Company | HMO/PPO/POS | $653 |
| Mercy - City Of Springfield | HMO/PPO/POS | $653 |
| Mercy - Employers Benefit Alliance | HMO/PPO/POS | $653 |
| First Health | HMO/PPO/POS | $653 |
| Mercy-American Healthcare Alliance | HMO/PPO/POS | $653 |
| Mercy - Health Systems Inc | HMO/PPO/POS | $653 |
| Mercy - Life Church | HMO/PPO/POS | $653 |
| Mercy - FirstHealth Network | HMO/PPO/POS | $653 |
| Mercy - Health Management Network | HMO/PPO/POS | $653 |
| Mercy - Liberty Utilities/Empire District Electric | HMO/PPO/POS | $653 |
| Mercy - Springfield Public Schools | HMO/PPO/POS | $653 |
| Mercy - WalMart Mercy Accountable Care Plan | HMO/PPO/POS | $653 |
| Mercy - Commerce Bank | HMO/PPO/POS | $653 |
| Mercy - Prime Health Services | HMO/PPO/POS | $653 |
| Mercy - Springfield Remanufacturing | HMO/PPO/POS | $653 |
| Mercy - Evolutions | HMO/PPO/POS | $653 |
| Mercy - ShineSolar | HMO/PPO/POS | $653 |
| Mercy - Trailiner | HMO/PPO/POS | $653 |
| BCBS - Traditional | Traditional | $681 |
Inpatient
$256cash price (self-pay)
$817list price
$222–$1,139range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Healthlink | HMO/PPO/POS | $531 |
| Phcs | HMO/PPO/POS | $653 |
| Mercy - ClayCo | HMO/PPO/POS | $653 |
| Mercy - Missouri State University | HMO/PPO/POS | $653 |
| Mercy - QuikTrip Corporation | HMO/PPO/POS | $653 |
| Mercy - C.B. Management Company/Joplin Supply Company | HMO/PPO/POS | $653 |
| Mercy - City Of Springfield | HMO/PPO/POS | $653 |
| Mercy - Employers Benefit Alliance | HMO/PPO/POS | $653 |
| Mercy-American Healthcare Alliance | HMO/PPO/POS | $653 |
| Mercy - Health Systems Inc | HMO/PPO/POS | $653 |
| Mercy - Life Church | HMO/PPO/POS | $653 |
| Mercy - FirstHealth Network | HMO/PPO/POS | $653 |
| Mercy - Health Management Network | HMO/PPO/POS | $653 |
| Mercy - Liberty Utilities/Empire District Electric | HMO/PPO/POS | $653 |
| Mercy - Springfield Public Schools | HMO/PPO/POS | $653 |
| Mercy - WalMart Mercy Accountable Care Plan | HMO/PPO/POS | $653 |
| Mercy - Commerce Bank | HMO/PPO/POS | $653 |
| Mercy - Prime Health Services | HMO/PPO/POS | $653 |
| Mercy - Springfield Remanufacturing | HMO/PPO/POS | $653 |
| Mercy - Evolutions | HMO/PPO/POS | $653 |
| Mercy - ShineSolar | HMO/PPO/POS | $653 |
| Mercy - Trailiner | HMO/PPO/POS | $653 |
| Mercy - Diversified Plastics | HMO/PPO/POS | $653 |
| Mercy - Fabick CAT | HMO/PPO/POS | $653 |
| Mercy - SumnerOne | HMO/PPO/POS | $653 |
| Mercy - Humana Commercial | HMO/PPO/POS | $694 |
| Mercy-Aetna | HMO/PPO/POS | $727 |
| Mercy - CompResults | HMO/PPO/POS | $735 |
| Mercy - Corvel Corporation | HMO/PPO/POS | $735 |
| Aetna Commercial | HMO/PPO/POS | $735 |
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