Emergency visit, moderate (level 3) at Good Samaritan Hospital. CPT 99283.
What Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated June 29, 2026.
Outpatient / ER
$5,842cash price (self-pay)
$5,842list price
$193–$11,525range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Beacon Commercial | Beacon Commercial | $193 |
| Oxford Exchange | Oxford Exchange | $1,530 |
| UHC Exchange | UHC Exchange | $1,530 |
| Oxford Commercial | Oxford Commercial | $1,718 |
| SELF-PAY - CC 30% | SELF-PAY - CC 30 PerCent | $1,753 |
| UHC Commercial | UHC Commercial | $1,800 |
| UHC Empire | UHC Empire | $1,800 |
| Beacon Medicare | Beacon Medicare | $1,916 |
| Hamaspik (Mcr) | Hamaspik (Mcr) | $1,916 |
| Medicare Managed | Medicare Managed | $1,916 |
| Mvp Gold (Mcr) | Mvp Gold (Mcr) | $1,916 |
| World Trade Center Fdny | World Trade Center Fdny | $1,916 |
| World Trade Center Other | World Trade Center Other | $1,916 |
| Medicare | Medicare | $1,917 |
| Emblem Select Care (Exchange) | Emblem Select Care (Exchange) | $1,943 |
| Emblem Ghi/Hip Medicare | Emblem Ghi/Hip Medicare | $1,954 |
| Blue Cross Connection/Exchange | Blue Cross Connection/Exchange | $2,009 |
| Affinity By Molina Mcr | Affinity By Molina Mcr | $2,012 |
| Health First Medicare | Health First Medicare | $2,050 |
| Blue Cross Access | Blue Cross Access | $2,142 |
| Emblem Ghi/Hip HMO/EPO/POS | Emblem Ghi/Hip HMO/EPO/POS | $2,286 |
| Emblem Ghi/Hip PPO | Emblem Ghi/Hip PPO | $2,286 |
| Beacon Exchange | Beacon Exchange | $2,299 |
| Blue Cross HMO | Blue Cross HMO | $2,350 |
| Blue Cross Small Group | Blue Cross Small Group | $2,410 |
| Magnacare Preferred | Magnacare Preferred | $2,434 |
| Mvp Exchange | Mvp Exchange | $2,442 |
| Aetna HP Network | Aetna HP Network | $2,676 |
| Cdphp | Cdphp | $2,687 |
| Self-Pay | Self-Pay | $2,785 |
Inpatient
$5,842cash price (self-pay)
$5,842list price
$1,753–$4,089range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| SELF-PAY - CC 30% | SELF-PAY - CC 30 PerCent | $1,753 |
| Cdphp | Cdphp | $2,921 |
| Self-Pay - Cc 50% | Self-Pay - Cc 50 | $2,921 |
| Magnacare Standard | Magnacare Standard | $4,089 |
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