Emergency visit, high (level 4) at Good Samaritan University Hospital. CPT 99284.
What Good Samaritan University Hospital publishes for this service, straight from its standard-charges file, last updated February 19, 2026.
Outpatient / ER
—cash price (self-pay)
$2,558list price
$207–$2,590range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS-NY Empire | MA | $494 |
| Aetna | Medicare | $504 |
| Centerlight Healthcare | PACE | $504 |
| Centers Plan For Healthy Living | Medicare | $504 |
| Elderplan Inc. | MA | $504 |
| Emblem Health | Medicare HMO | $504 |
| Fidelis Care New York | DUAL | $504 |
| Fidelis Care New York | MA | $504 |
| Fidelis Care New York | MLTC | $504 |
| Agewell New York | Medicare HMO | $522 |
| Brighton | LOCAL 3 MAGNA JIB | $1,641 |
| Allied Wellfare Fund | Commercial | $1,663 |
| American Group Administrators | Commercial | $1,663 |
| Bakery & Confectionery Union | Commercial | $1,663 |
| Cigna | Indemnity | $1,663 |
| Comprehensive Benefits Consultant | Commercial | $1,663 |
| Centivo | Commercial | $1,755 |
| BCBS-NY Empire | Blue Access Small Group | $1,808 |
| Brighton | Direct Plus | $1,888 |
| Brighton | PPO | $1,888 |
| Coventry | HMO | $1,893 |
| Brighton | Create IDN | $2,025 |
| Aetna | Narrow Network | $2,052 |
| Brighton | Create Flex | $2,083 |
| BCBS-NY Empire | Blue Access Large Group | $2,142 |
| Coventry | First Health PPO | $2,174 |
| APWU | Commercial | $2,186 |
| Centivo | PPO Cigna Medical | $2,186 |
| Cigna | Commercial | $2,186 |
| Daniel H Cook | Associates | $2,186 |
Billed more than this?
Scan my billSnap a photo of your bill. We compare every line with these prices and coding rules, free.