Emergency visit, high (level 4) at Tj Health Samson Community Hospital. CPT 99284.
What Tj Health Samson Community Hospital publishes for this service, straight from its standard-charges file, last updated April 23, 2026.
Outpatient / ER
$195cash price (self-pay)
$300list price
$0.01–$1,450range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| UHC All Payer - All Plans | UHC All Payer - All Plans | $0.01 |
| Blue Cross Mcr Adv | Blue Cross Mcr Adv | $116 |
| Blue Cross Mcr Select | Blue Cross Mcr Select | $116 |
| Center Care Select - All Plans | Center Care Select - All Plans | $116 |
| Signature Health - All Plans | Signature Health - All Plans | $116 |
| Wellcare Mcr Adv - All Other Plans | Wellcare Mcr Adv - All Other Plan | $116 |
| Molina Mcr Adv | Molina Mcr Adv | $118 |
| Humana Mcr Adv - All Other Plans | Humana Mcr Adv - All Other Plans | $119 |
| Devoted Mcr Adv - All Plans | Devoted Mcr Adv - All Plans | $121 |
| Caresource - All Plans | Caresource - All Plans | $150 |
| Molina Marketplace - All Other Plans | Molina Marketplace - All Other | $150 |
| Aetna Better Health Mcaid - All Plans | Aetna Better Health Mcaid - Al | $300 |
| Humana Mcaid | Humana Mcaid | $300 |
| Wellcare Mcaid | Wellcare Mcaid | $300 |
| Molina Mcaid | Molina Mcaid | $309 |
| Phcs/Multiplan - All Plans | Phcs/Multiplan - All Plans | $1,002 |
| First Health - All Plans | First Health - All Plans | $1,013 |
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