Emergency visit, high (level 4) at Advocate Good Samaritan Hospital. CPT 99284.
What Advocate Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated November 4, 2025.
Outpatient / ER
$1,255cash price (self-pay)
$2,510list price
$644–$3,426range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Ambetter | Medicare Advantage | $644 |
| Molina | Medicare Advantage | $644 |
| Oscar Health HMO | Medicare Advantage | $666 |
| HSTechnology | Medicare Advantage | $852 |
| Advocate Employee | Commercial | $989 |
| Cigna One Health | Commercial | $1,305 |
| Aetna | Commercial | $1,354 |
| Blue Cross Blue Shield City of Chicago | Commercial | $1,399 |
| Blue Cross Blue Shield Choice | Commercial | $1,513 |
| Blue Cross Blue Shield | PPO | $1,592 |
| United Healthcare Charter | Commercial | $1,733 |
| Blue Cross Blue Shield Blue Precision | Managed Care | $1,940 |
| Blue Cross Blue Shield | HMO | $1,978 |
| Multiplan | Commercial | $2,008 |
| Private Healthcare Systems | Commercial | $2,008 |
| United Healthcare Nexus | Commercial | $2,008 |
| United Healthcare Core Navigate | Commercial | $2,960 |
| Cigna | Commercial | $3,263 |
| United Healthcare | HMO | $3,426 |
Inpatient
$1,255cash price (self-pay)
$2,510list price
$1,097–$2,008range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Advocate Employee | Commercial | $1,097 |
| Private Healthcare Systems | Commercial | $1,556 |
| Multiplan | Commercial | $2,008 |
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