Emergency visit, high (level 4) at Samaritan Lebanon Community Hospital. CPT 99284.
What Samaritan Lebanon Community Hospital publishes for this service, straight from its standard-charges file, last updated January 31, 2026.
Outpatient / ER
$365cash price (self-pay)
$456list price
$102–$1,940range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Devoted Health | Medicare Advantage - Midlevel - Nonfac | $114 |
| Devoted Health | Medicare Advantage - Midlevel - Fac | $114 |
| Healthnet | Medicare Advantage - Midlevel - Fac | $114 |
| Healthnet | Medicare Advantage - Midlevel - Nonfac | $114 |
| DEVOTED HEALTH | Medicare Advantage-NONFAC | $130 |
| DEVOTED HEALTH | Medicare Advantage-FAC | $130 |
| Healthnet | Medicare Advantage - Nonfac | $134 |
| Cigna | Nonfacility | $170 |
| Cigna | Facility | $170 |
| Aetna | Fac - Midlevel Lcsw/Lpc/Rdn | $200 |
| Aetna | Nonfac - Midlevel Lcsw/Lpc/Rdn | $200 |
| Aetna | Nonfac - Optometrists - Pyschologists- Pt-St-Ot | $227 |
| Aetna | Nonfac - Midlevel Np-Pa-Cnm | $227 |
| Aetna | Fac - Optometrists - Pyschologists- Pt-St-Ot | $227 |
| Aetna | Fac - Midlevel Np-Pa-Cnm | $227 |
| Healthnet | Nonfacility | $248 |
| Aetna | Nonfac - Md-Do | $267 |
| Aetna | Fac - Md-Do | $267 |
| Aetna | Fac - Psychiatric Np | $267 |
| Aetna | Nonfac - Psychiatric Np | $267 |
| First Choice | Facility | $270 |
| First Choice | Nonfacility | $270 |
| Providence | Medicare Adv. - Physician | $274 |
| Providence | Medicare Adv. | $580 |
| Providence | MA-Behavioral Health | $580 |
| Samaritan | Medicare Adv. | $586 |
| Healthnet | Medicare Adv. | $638 |
| Regence | Medicare Adv. | $638 |
| Pacificsource | Medicare Adv. | $650 |
| Devoted Health | Devoted Health Mcr Advantage | $667 |
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