Emergency visit, high (level 4) at MedStar Good Samaritan Hospital. CPT 99284.
What MedStar Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$621cash price (self-pay)
$634list price
$621–$634range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna US HealthCare Inc | Aetna All HMO and PPO Plans | $634 |
| Aetna Medicare | Aetna Medicare | $634 |
| AmeriGroup | AmeriGroup DC | $634 |
| AmeriHealth Caritas District of Columbia | AmeriHealth | $634 |
| CareFirst Blue Choice Inc | All Carefirst HMO Plans | $634 |
| CareFirst Blue Choice Inc | All Carefirst PPO Plans | $634 |
| CareFirst Advantage Inc | CareFirst Medicare Advantage | $634 |
| Tricare | Tricare | $634 |
| Cigna Healthspring | Cigna Healthspring | $634 |
| Cigna HealthCare Mid Atlantic | All Cigna HMO | $634 |
| Cigna HealthCare MidAtlantic Inc | All Cigna PPO | $634 |
| Humana | Humana Choice Care | $634 |
| First Health | First Health | $634 |
| Pfc | Pfc | $634 |
| Hscsn | Hscsn | $634 |
| Humana | Humana Medicare Advantage | $634 |
| Kaiser Permanente | All Kaiser Commercial | $634 |
| Kaiser Permanente | Kaiser MD MCO | $634 |
| Kaiser Permanente | Kaiser Medicare Advantage | $634 |
| Kaiser Permanente | Kaiser VA MCO | $634 |
| United Healthcare | UnitedHealthcare Community Plan of Maryland | $634 |
| Magellan Behavioral Health Inc | Magellan Behavioral Health Inc | $634 |
| MAMSI | MAMSI MDIPA/Optimum Choice | $634 |
| Medstar Family Choice Inc | Medstar Family Choice DC | $634 |
| Medstar Family Choice | Medstar Family Choice MD | $634 |
| NCPPO Healthlink PPO | NCPPO | $634 |
| UnitedHealthcare Insurance Company | Optum VA Community Care | $634 |
| Private HealthCare Systems (PHCS) | Private HealthCare Systems (PHCS) | $634 |
| United Behavioral Health Inc | UBH All Products | $634 |
| United Healthcare | UHC Navigate/Core | $634 |
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