Emergency visit, highest (level 5) at Good Samaritan Hospital (GSH). CPT 99285.
What Good Samaritan Hospital (GSH) publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$1,404cash price (self-pay)
$2,340list price
$147–$2,340range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Medicaid | $160 |
| Caresource HIP | Medicaid | $160 |
| Caresource | Medicaid | $160 |
| Aetna | Medicare Advantage | $396 |
| Allwell | MCR ADV/PPO/HMO | $396 |
| Anthem MCR | MCR ADV/PPO/HMO | $396 |
| Anthem MCR | Medicare Advantage | $396 |
| Anthem | MCR ADV/PPO/HMO | $396 |
| Cigna | Medicare Advantage | $396 |
| Humana | Medicare Advantage | $396 |
| United Healthcare | Medicare Advantage | $396 |
| Alliance Coal | Commercial | $569 |
| CareSource | Commercial | $574 |
| Indiana University | MCR ADV/PPO/HMO | $630 |
| MHS Ambetter | Commercial | $630 |
| Meridian | Medicare Advantage | $630 |
| Molina | Medicaid | $630 |
| Molina | Medicare Advantage | $630 |
| Optum | MCR ADV/PPO/HMO | $630 |
| Hope Trust | Commercial | $792 |
| Aetna | Commercial | $920 |
| Encore Prime | Commercial | $1,126 |
| Amish | Commercial | $1,170 |
| Anthem | Exchange | $1,335 |
| United Healthcare | Commercial | $1,535 |
| Anthem | Trad/PPO/HMO | $1,669 |
| OneCare | Commercial | $1,783 |
| Indiana University | Commercial | $1,783 |
| Direct Health | Direct Health | $1,795 |
| SIHO | Commercial | $1,795 |
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