IV push, single drug at CHI Health Good Samaritan. CPT 96374.
What CHI Health Good Samaritan publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
$465cash price (self-pay)
$762list price
$69.55–$709range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medica | Commercial|ACO | $69.55 |
| Medica | Commercial|CHI Health | $70.81 |
| Medica | Commercial|All Other Plans | $74.15 |
| United | Medicaid|Community Plan | $160 |
| Centene | Medicaid|NE Total Care | $162 |
| Amerigroup | Medicaid|All Plans | $172 |
| Centene | Medicaid|IA Total Care | $172 |
| IAMolina | Medicaid|All Plans | $175 |
| BCBS - NE | Medicare|All Plans | $199 |
| Humana | Medicare|All Plans | $199 |
| Medica | Medicare|All Plans | $199 |
| PACE | Medicare|All Plans | $199 |
| United | Medicare|All Plans | $199 |
| Centene | Medicare|All Plans | $205 |
| Amerigroup | Medicare|All Plans | $209 |
| Great Plains | Medicare|All Plans | $209 |
| Creighton University Employees | Commercial|All Plans | $373 |
| ELAP | Commercial|All Plans | $442 |
| AMPS | Commercial|All Plans | $443 |
| United | Commercial|All Plans | $579 |
| Medica | Commercial|Open Access | $594 |
| Midlands Choice | Commercial|Premier | $594 |
| Midlands Choice | Commercial|Standard | $701 |
| MultiPlan PHCS | Commercial|All Plans | $709 |
Inpatient
$465cash price (self-pay)
$762list price
$373–$709range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Creighton University Employees | Commercial|All Plans | $373 |
| United | Commercial|All Plans | $579 |
| Medica | Commercial|Open Access | $594 |
| Midlands Choice | Commercial|Premier | $594 |
| Midlands Choice | Commercial|Standard | $701 |
| MultiPlan PHCS | Commercial|All Plans | $709 |
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