Emergency visit, highest (level 5) at Intermountain Health Good Samaritan Medical Center. CPT 99285.
What Intermountain Health Good Samaritan Medical Center publishes for this service, straight from its standard-charges file, last updated March 22, 2026.
Outpatient / ER
—cash price (self-pay)
$10,353list price
$610–$9,287range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $1,915 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $2,381 |
| Kaiser Perm HMO | Kaiser Out Of State | $2,381 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $2,381 |
| Kaiser Self Funded | Kaiser Self Funded | $2,381 |
| Kaiser Perm PPO/POS | Kaiser Perm PPO/POS | $2,416 |
| Allegiance | Cigna Sclhs Employees | $2,588 |
| Aetna | Aetna Colorado Preferred | $3,851 |
| BCBS/Anthem | BCBS Co Federal | $4,119 |
| BCBS/Anthem | BCBS Co HMO | $4,119 |
| BCBS/Anthem | BCBS Co PPO | $4,119 |
| Aetna | Aetna HMO/EPO | $4,131 |
| Aetna | Aetna Indemnity | $4,131 |
| Aetna | Aetna Other | $4,131 |
| Aetna | Aetna POS/Qpos | $4,131 |
| Aetna | Aetna PPO | $4,131 |
| Aetna | Aetna Src | $4,131 |
| Choicecare Humana | Choicecare Humana HMO EPO | $4,348 |
| Choicecare Humana | Choicecare Humana PPO | $4,348 |
| Cigna | Cigna HMO | $5,927 |
| Cigna | Cigna Indemnity | $5,927 |
| Cigna | Cigna Local Plus | $5,927 |
| Cigna | Cigna Other | $5,927 |
| Cigna | Cigna POS/Qpos | $5,927 |
| Cigna | Cigna PPO | $5,927 |
| Cigna | Eighth Dist Elect Ben Pln | $5,927 |
| Cigna | Health-Partners | $5,927 |
| Geha | Geha | $6,005 |
| Geha | Geha Mcr Supplemental | $6,005 |
| United Healthcare | All Savers Alternative Funding | $6,005 |
Inpatient
—cash price (self-pay)
$10,353list price
$3,054–$10,353range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $3,054 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $4,362 |
| Kaiser Perm HMO | Kaiser Out Of State | $4,362 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $4,362 |
| Kaiser Self Funded | Kaiser Self Funded | $4,362 |
| Kaiser Perm PPO/POS | Kaiser Perm PPO/POS | $4,494 |
| Private Hlthcare Sys | Phcs Other | $7,765 |
| Private Hlthcare Sys | Phcs PPO | $7,765 |
| BCBS/Anthem | BCBS Co Indemnity | $8,715 |
| Multiplan Inc | Multiplan Inc Other | $8,800 |
| Multiplan Inc | Multiplan Inc PPO | $8,800 |
| Aetna | Aetna Nap | $9,287 |
| Cigna | Cigna HMO | $10,353 |
| Cigna | Cigna Indemnity | $10,353 |
| Cigna | Cigna Local Plus | $10,353 |
| Cigna | Cigna Other | $10,353 |
| Cigna | Cigna POS/Qpos | $10,353 |
| Cigna | Cigna PPO | $10,353 |
| Cigna | Eighth Dist Elect Ben Pln | $10,353 |
| Cigna | Health-Partners | $10,353 |
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All common services at Intermountain Health Good Samaritan Medical Center