Emergency visit, high (level 4) at Good Samaritan Hospital. CPT 99284.
What Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$13,840cash price (self-pay)
$13,840list price
$98.04–$13,840range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Physicians Medical Group | MCD | $98.04 |
| Physician Health Network | MGMCD | $108 |
| United | OptionsPPO | $3,529 |
| Bright Health | COMM | $5,845 |
| United | GlobalBenefitPlan | $6,228 |
| United | AllPayerAppendix | $6,902 |
| Santa Clara IPA COMM | COMM | $6,920 |
| Santa Clara IPA MCR | MCR | $6,920 |
| NX Health Network | COMM | $8,304 |
| Sutter Select | COMM | $8,304 |
| Anthem | ExchangeEPO | $8,726 |
| Anthem | BlueConnection | $9,202 |
| Anthem | COMM | $9,202 |
| ChoiceCare Humana | COMM | $9,688 |
| Aetna | AWH | $9,982 |
| Aetna | HMO | $10,186 |
| Aetna | PPO | $10,186 |
| First Health | COMM | $10,518 |
| Cigna BH | COMMBH | $11,072 |
| HealthSmart | WCOMP | $11,072 |
| Intercontinental Corporation | COMM | $11,072 |
| MultiPlan | Complementary | $11,072 |
| PHA Pacific Health Alliance | COMM | $11,072 |
| PPO Next | COMM | $11,072 |
| PPO Next | PPO | $11,072 |
| HealthSmart | COMM | $11,764 |
| Cigna | LocalPlus | $12,950 |
| Cigna | HMO | $13,777 |
| Cigna | POS | $13,777 |
| Cigna | PPO | $13,777 |
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