Emergency visit, highest (level 5) at Good Samaritan Hospital. CPT 99285.
What Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$21,255cash price (self-pay)
$21,255list price
$155–$21,255range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Physicians Medical Group | MCD | $155 |
| Physician Health Network | MGMCD | $171 |
| United | OptionsPPO | $5,420 |
| Bright Health | COMM | $5,845 |
| Anthem | ExchangeEPO | $8,726 |
| Anthem | BlueConnection | $9,209 |
| Anthem | COMM | $9,209 |
| United | GlobalBenefitPlan | $9,565 |
| Santa Clara IPA COMM | COMM | $10,628 |
| Santa Clara IPA MCR | MCR | $10,628 |
| United | AllPayerAppendix | $12,455 |
| Aetna | AWH | $12,675 |
| NX Health Network | COMM | $12,753 |
| Sutter Select | COMM | $12,753 |
| Aetna | HMO | $12,934 |
| Aetna | PPO | $12,934 |
| Cigna | LocalPlus | $14,210 |
| ChoiceCare Humana | COMM | $14,879 |
| Cigna | HMO | $15,117 |
| Cigna | POS | $15,117 |
| Cigna | PPO | $15,117 |
| First Health | COMM | $16,154 |
| Cigna BH | COMMBH | $17,004 |
| HealthSmart | WCOMP | $17,004 |
| Intercontinental Corporation | COMM | $17,004 |
| MultiPlan | Complementary | $17,004 |
| PHA Pacific Health Alliance | COMM | $17,004 |
| PPO Next | COMM | $17,004 |
| PPO Next | PPO | $17,004 |
| HealthSmart | COMM | $18,067 |
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