IV push, single drug at Pali Momi Medical Center. CPT 96374.
What Pali Momi Medical Center publishes for this service, straight from its standard-charges file, last updated February 12, 2026.
Outpatient / ER
$217cash price (self-pay)
$361list price
$25.20–$307range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Alohacare | Abd - Pediatric | $25.20 |
| Alohacare | Abd - Adult | $25.20 |
| Ohana | Quest - Abd | $25.94 |
| Blended Rate UHC | All Products | $36.88 |
| UHC | All Products | $36.88 |
| Hmsa | All Products | $78.06 |
| Hwmg/Hmaa | All Products | $127 |
| Alohacare | Medicare Advantage | $206 |
| Hmsa | Medicare Advantage | $206 |
| Mdx | Humana Medicare | $206 |
| Mdx | UHC Medicare | $206 |
| Ohana | Medicare Advantage | $215 |
| Devoted | Medicare Advantage | $217 |
| Ohana | Quest - Non-Abd | $250 |
| Calvos | Select Care | $271 |
| Mimoh | All Products | $271 |
| Uha | All Products | $271 |
| Alohacare | Non-Abd - Adult | $275 |
| Alohacare | Non-Abd - Pediatric | $275 |
| Hcha | All Products | $289 |
| Kaiser | All Products | $289 |
| Mdx | All Products | $289 |
| Pac Admin | All Products | $289 |
| Verdegard | Union Trust Fund | $289 |
| Coventry | All Products | $307 |
| Mccp | All Products | $307 |
| Multiplan | All Products | $307 |
Inpatient
$217cash price (self-pay)
$361list price
$271–$307range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Multiplan | All Products | $289 |
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