Emergency visit, high (level 4) at Samaritan Medical Center. CPT 99284.
What Samaritan Medical Center publishes for this service, straight from its standard-charges file, last updated February 2, 2026.
Outpatient / ER
$265cash price (self-pay)
$316list price
$108–$4,386range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Empire | Commercial | $108 |
| Fidelis | Medicare Advantage/Managed Long Term Care | $114 |
| Wellcare | Medicare Advantage | $114 |
| Fidelis | Medicaid Managed Care/Child Health Plus and Family Health Pl | $114 |
| Fidelis | Health Benefit Exchange | $125 |
| Fidelis | Essential Plan Program/Aliessa and Essential Plan Program-QH | $125 |
| Excellus | Commercial | $148 |
| Optum Behavioral Health | Commercial | $165 |
| Capital District Physician's Health Plan, Inc (CDPHP) | Commercial | $252 |
| Capital District Physician's Health Plan, Inc (CDPHP) | Medicare Advan | $521 |
| Excellus | Medicare Advantage | $521 |
| Aetna | Medicare Advantage | $531 |
| United Healthcare | Medicare Advantage | $536 |
| MVP | Medicare Advantage | $547 |
| MVP | Individual Commercial (HMO, EPO/PPO) Plans | $941 |
| MVP | Student Health Plans | $941 |
| MVP | Small/Large Group Commercial (HMO, EPO/PPO, ASO) Plans | $1,094 |
| UMR | Commercial | $1,122 |
| GHI Emblem | Commercial | $1,194 |
| United Healthcare | Commercial | $1,223 |
| Aetna | Commercial | $4,386 |
Inpatient
$1,439cash price (self-pay)
$1,439list price
$1,151–$1,151range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Capital District Physician's Health Plan, Inc (CDPHP) | Commercial | $1,151 |
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