Emergency visit, high (level 4) at SSM Health Good Samaritan Hospital - Mt. Vernon. CPT 99284.
What SSM Health Good Samaritan Hospital - Mt. Vernon publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$1,451cash price (self-pay)
$2,639list price
$447–$470range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Molina | Dual Eligible Medicare/Medicaid | $447 |
| UnitedHealthCare | Medicare Managed Care Plan | $465 |
| Essence Healthcare | Medicare Managed Care Plan | $470 |
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All common services at SSM Health Good Samaritan Hospital - Mt. Vernon