Emergency visit, high (level 4) at Samaritan Hospital. CPT 99284.
What Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$40.48cash price (self-pay)
$253list price
$10.10–$3,614range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Dentaquest | Pb Xr 100% Default | $147 |
| Health Choices | Pb Xr 100% Default | $147 |
| Everence | Pb Xr 100% Default | $147 |
| Molina Medicare Advantage | Pb Xr 100% Default | $147 |
| The Health Plan | Pb Xr 100% Default | $147 |
| Commonwealth Care Alliance | Pb Xr 100% Default | $147 |
| Pace Of Southwest Michigan | Pb Xr 100% Default | $147 |
| Union Health Service | Pb Xr 100% Default | $147 |
| Harvard Pilgrim Healthcare | Pb Xr 100% Default | $147 |
| Rx Allwin | Pb Xr 100% Default | $147 |
| Eddy Seniorcare Pace | Eddy Senior Care | $521 |
| Capital District Physicians Health Plan Medicare Advantage | Cdphp Med | $521 |
| Secure Horizons MA Pffs | United Healthcare Medicare Advantage | $531 |
| Aetna Medicare Advantage | Aetna Medicare Advantage | $551 |
| Vnsny Choice Medicare | Vns Choice | $552 |
| Hudson Headwaters Pace | Hudson Headwaters Pace | $563 |
| Fidelis Medicare | Fidelis Medicare Advantage | $569 |
| Blue Cross - NY (Excellus) Medicare Advantage | Blue Shield Of Ne New | $573 |
| Blue Shield - NY Highmark Northeastern Medicare Advantage | Blue Shiel | $573 |
| Fidelis Care | Fidelis Health Benefit Exchange | $938 |
| Blue Cross - Me (Anthem) | Empire BCBS HMO EPO PPO Indemnity | $1,198 |
| Blue Cross - Sd (Wellmark) | Empire BCBS HMO EPO PPO Indemnity | $1,198 |
| Blue Cross Domestic | Empire BCBS HMO EPO PPO Indemnity | $1,198 |
| Blue Cross - Mo (Anthem) | Empire BCBS HMO EPO PPO Indemnity | $1,198 |
| Blue Cross - Oh (Anthem) | Empire BCBS HMO EPO PPO Indemnity | $1,198 |
| Albany County Correctional Facility | Albany Correctional Facility | $1,427 |
| Blue Cross - Nj (Horizon) | Blue Shield Of Ne New York HMO | $1,732 |
| Capital District Physicians Health Plan | Cdphp | $1,982 |
| United Healthcare | United Healthcare | $2,022 |
| Blue Cross - Mt | Blue Shield Of Ne New York PPO | $2,165 |
Inpatient
$309cash price (self-pay)
$309list price
$76.68–$309range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| The Health Plan | Pb Xr 100% Default | $309 |
| Commonwealth Care Alliance | Pb Xr 100% Default | $309 |
| Dentaquest | Pb Xr 100% Default | $309 |
| Pace Of Southwest Michigan | Pb Xr 100% Default | $309 |
| Molina Medicare Advantage | Pb Xr 100% Default | $309 |
| Union Health Service | Pb Xr 100% Default | $309 |
| Harvard Pilgrim Healthcare | Pb Xr 100% Default | $309 |
| Rx Allwin | Pb Xr 100% Default | $309 |
| Everence | Pb Xr 100% Default | $309 |
| Health Choices | Pb Xr 100% Default | $309 |
| Delta Dental Oh | Pb Xr 100% Default | $309 |
| Medical Mutual Medicare | Pb Xr 100% Default | $309 |
| Theramatrix Physical Therapy Network | Pb Xr 100% Default | $309 |
| La Care Health Plan | Pb Xr 100% Default | $309 |
| Healthy Blue Ne | Pb Xr 100% Default | $309 |
| Proctor Preferred | Pb Xr 100% Default | $309 |
| Physicians Mutual | Pb Xr 100% Default | $309 |
| Adamh Board | Pb Xr 100% Default | $309 |
| Mo Home State Health Plan | Pb Xr 100% Default | $309 |
| Mutual Of Omaha | Pb Xr 100% Default | $309 |
| Blue Plus Mo Medicaid | Pb Xr 100% Default | $309 |
| Healthy Blue Plus Mo Medicaid | Pb Xr 100% Default | $309 |
| Wc Claims Mgmt Inc | Pb Xr 100% Default | $309 |
| Meridian Medicaid | Pb Xr 100% Default | $309 |
| Wc Fresno Unified Emp | Pb Xr 100% Default | $309 |
| Molina Medicaid | Pb Xr 100% Default | $309 |
| Wc Hab | Pb Xr 100% Default | $309 |
| Nextlevel Health | Pb Xr 100% Default | $309 |
| Rx Optima | Pb Xr 100% Default | $309 |
| Wellcare Medicaid | Pb Xr 100% Default | $309 |
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