Emergency visit, high (level 4) at HSS Southampton Outpatient Center. CPT 99284.
What HSS Southampton Outpatient Center publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$806cash price (self-pay)
$806list price
$54.02–$296range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Metro Plus | Medicaid Managed Care | $54.02 |
| Metro Plus | Essential Plans 3,4 | $54.02 |
| Metro Plus | Essential Plans 1,2 | $56.27 |
| Fidelis | Medicaid Managed Care | $100 |
| Fidelis | Essential Plans 3,4 | $100 |
| Fidelis | Essential Plans 1,2 | $120 |
| Emblem | Medicare Managed Care | $133 |
| UHC | Medicare Managed Care | $133 |
| CIGNA | Commercial | $233 |
| Emblem | Commercial | $235 |
| Emblem | City of NY Plans | $235 |
| Anthem NY | Exchange | $247 |
| NYSHIP | Commercial | $250 |
| Aetna | Commercial | $275 |
| UHC | Commercial | $289 |
| Anthem NY | Commercial | $291 |
| Horizon | Commercial | $296 |
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