IV push, single drug at Good Samaritan Hospital (GSH). CPT 96374.
What Good Samaritan Hospital (GSH) publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$164cash price (self-pay)
$274list price
$31.49–$450range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Medicaid | $31.49 |
| Caresource HIP | Medicaid | $31.49 |
| Caresource | Medicaid | $31.49 |
| Encore Prime | Commercial | $41.61 |
| Aetna | Commercial | $72.48 |
| Direct Health | Direct Health | $123 |
| Anthem | Trad/PPO/HMO | $130 |
| Aetna | Medicare Advantage | $130 |
| Allwell | MCR ADV/PPO/HMO | $130 |
| Anthem MCR | MCR ADV/PPO/HMO | $130 |
| Anthem MCR | Medicare Advantage | $130 |
| Anthem | MCR ADV/PPO/HMO | $130 |
| Cigna | Medicare Advantage | $130 |
| Humana | Medicare Advantage | $130 |
| United Healthcare | Medicare Advantage | $130 |
| OneCare | Commercial | $131 |
| Amish | Commercial | $137 |
| Anthem | Exchange | $156 |
| HealthLink | HMO | $158 |
| HealthLink | PPO | $165 |
| United Healthcare | Commercial | $180 |
| Alliance Coal | Commercial | $186 |
| CareSource | Commercial | $191 |
| Indiana University | Commercial | $209 |
| SIHO | Commercial | $210 |
| Cigna | Commercial | $216 |
| Sagamore | Commercial | $216 |
| Corvel | Workers Comp | $225 |
| Indiana University | MCR ADV/PPO/HMO | $225 |
| MHS Ambetter | Commercial | $225 |
Inpatient
$164cash price (self-pay)
$274list price
$159–$274range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Exchange | $159 |
| United Healthcare | Commercial | $181 |
| Anthem | Trad/PPO/HMO | $199 |
| Direct Health | Direct Health | $210 |
| SIHO | Commercial | $210 |
| Cigna | Commercial | $216 |
| Sagamore | Commercial | $216 |
| Corvel | Workers Comp | $225 |
| Aetna | Commercial | $230 |
| Anthem | HealthSync | $236 |
| HealthLink | HMO | $241 |
| Encore Prime | Commercial | $247 |
| Humana | Commercial | $247 |
| HealthLink | PPO | $255 |
| Molina | Medicaid | $274 |
| Underwriters Safety | Commercial | $274 |
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