IV push, single drug at Samuel Mahelona Memorial Hospital. CPT 96374.
What Samuel Mahelona Memorial Hospital publishes for this service, straight from its standard-charges file, last updated June 15, 2026.
Outpatient / ER
$192cash price (self-pay)
$430list price
$24.47–$1,600range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| UnitedHealthcare | Medicaid | $36.88 |
| AlohaCare | Medicaid | $215 |
| AlohaCare | Medicare | $215 |
| Ohana Health Plan | Medicaid | $215 |
| Ohana Health Plan | Medicare | $215 |
| Humana | Medicare | $225 |
| Hawaii Medical Service Association | Medicare | $235 |
| Kaiser Permanente | Medicare | $235 |
| UnitedHealthcare | Medicare | $235 |
| Devoted Health | Medicare | $237 |
| Kaiser Permanente | Commercial | $285 |
| University Health Alliance | Commercial | $288 |
| Health Management Network | Commercial | $366 |
| Hawaii Western Management Group | Commercial | $409 |
| Kaiser Permanente | Medicaid | $434 |
| MDX Hawaii | PPO | $436 |
| Hawaii Medical Service Association | Non-ABD | $450 |
| Hawaii Medical Service Association | ABD | $469 |
| Hawaii Medical Service Association | Commercial | $936 |
Inpatient
$280cash price (self-pay)
$450list price
$366–$455range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Management Network | Commercial | $382 |
| Kaiser Permanente | Commercial | $405 |
| MDX Hawaii | PPO | $436 |
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