IV push, single drug at Gundersen Palmer Lutheran Hospital and Clinic. CPT 96374.
What Gundersen Palmer Lutheran Hospital and Clinic publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$208cash price (self-pay)
$350list price
$22.55–$340range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | Medicaid HMO | $22.55 |
| Molina Health | Managed Medicaid | $22.55 |
| Wellmark | HMO | $119 |
| Wellmark | Indemnity/PPO | $130 |
| Quartz | All Products | $148 |
| Quartz | All Other Self Funded | $154 |
| Quartz | Self Funded | $165 |
| Quartz | Level Funded | $170 |
| UHC | All Payer Appendix | $174 |
| Health Partners | Medicaid HMO | $175 |
| Wellmark | All Products | $179 |
| Aetna | Medicare Advantage | $182 |
| Amerigroup | Medicare Advantage | $182 |
| Health Partners | Medicare Advantage | $182 |
| Humana | Medicare Advantage | $182 |
| Iowa Total Care | Medicaid | $182 |
| Managed Health Service | Managed Medicaid | $182 |
| Quartz | Medicaid_Badgercare | $182 |
| Quartz | Medicare Advantage | $182 |
| UHC | Medicare Advantage | $182 |
| Wellmark | Medicare Advantage | $182 |
| Quartz | Fully Insured | $191 |
| UCARE | Dually Eligible | $193 |
| UCARE | Non-Dually Eligible | $193 |
| UCARE | MSHO/Minnesota Special Needs | $193 |
| Health Partners | Medicare Cost | $210 |
| Alliance | Comprehensive/All Products | $277 |
| Alliance | Premier/All Products | $277 |
| Medical Associates | CAH Specific | $280 |
| Trilogy | All Products | $280 |
Inpatient
$208cash price (self-pay)
$350list price
$148–$340range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Other Self Funded | $206 |
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All common services at Gundersen Palmer Lutheran Hospital and Clinic