Emergency visit, moderate (level 3) at Good Samaritan Hospital (GSH). CPT 99283.
What Good Samaritan Hospital (GSH) publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$628cash price (self-pay)
$1,046list price
$59.77–$2,000range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Medicaid | $81.10 |
| Caresource HIP | Medicaid | $81.10 |
| Caresource | Medicaid | $81.10 |
| Anthem HIP | HIP | $81.43 |
| BCBS | Medicare Advantage | $81.43 |
| Aetna | Medicaid | $97.50 |
| Anthem Pathways | Medicaid | $97.50 |
| Aetna | Medicare Advantage | $177 |
| Allwell | MCR ADV/PPO/HMO | $177 |
| Anthem MCR | MCR ADV/PPO/HMO | $177 |
| Anthem MCR | Medicare Advantage | $177 |
| Anthem | MCR ADV/PPO/HMO | $177 |
| Cigna | Medicare Advantage | $177 |
| Humana | Medicare Advantage | $177 |
| United Healthcare | Medicare Advantage | $177 |
| Alliance Coal | Commercial | $256 |
| CareSource | Commercial | $257 |
| Indiana University | MCR ADV/PPO/HMO | $289 |
| MHS Ambetter | Commercial | $289 |
| Hope Trust | Commercial | $354 |
| Aetna | Commercial | $406 |
| Encore Prime | Commercial | $501 |
| Amish | Commercial | $523 |
| Anthem | Exchange | $597 |
| United Healthcare | Commercial | $686 |
| Anthem | Trad/PPO/HMO | $746 |
| OneCare | Commercial | $797 |
| Indiana University | Commercial | $797 |
| Direct Health | Direct Health | $802 |
| SIHO | Commercial | $802 |
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