Emergency visit, high (level 4) at WellSpan Good Samaritan Hospital. CPT 99284.
What WellSpan Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$1,810cash price (self-pay)
$2,263list price
$154–$3,223range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Geisinger_Medicaid | All_Plans | $154 |
| Health_Partners_Medicaid | All_Other_Plans | $154 |
| PA_Health_&_Wellness_Medicaid | All_Plans | $154 |
| UPMC_Medicaid | All_Plans | $154 |
| Amerihealth_Caritas_Medicaid | All_Plans | $175 |
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $255 |
| Aetna_Better_Health_Kids | All_Plans | $418 |
| Blue_Cross_BlueJourney_Medicare | All_Plans | $421 |
| Highmark_Medicare | All_Plans | $425 |
| Aetna_Advantra_Medicare | All_Plans | $433 |
| Aetna_Medicare | All_Plans | $433 |
| Geisinger_Gold_Medicare | All_Plans | $442 |
| Devoted_Medicare | All_Plans | $442 |
| United_Medicare | ISNP_DSNP_Plans | $442 |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $444 |
| Amerihealth_Medicare | All_Plans | $444 |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $444 |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $444 |
| Jefferson_Health_Medicare_Advantage | All_Plans | $454 |
| PA_Health_&_Wellness_Medicare | All_Plans | $454 |
| Highmark | Higmark_Healthy_Kids | $652 |
| Health_Partners_Medicaid | Kidz_Partners | $694 |
| United_Medicaid | Community_Plan_For_Kids | $736 |
| Cigna | All_Plans | $1,250 |
| Highmark | Choice_Blue_PPO | $1,272 |
| Highmark | Performance_Blue | $1,272 |
| Highmark | Blue_Cross_High_Performance_Network | $1,272 |
| WellSpan_Capital_Blue_Cross | All_Plans | $1,358 |
| Geisinger | All_Plans | $1,358 |
| UPMC | UPMC_For_Kids | $1,358 |
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