IV push, single drug at Nicholas H Noyes Memorial Hospital. CPT 96374.
What Nicholas H Noyes Memorial Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$116cash price (self-pay)
$623list price
$17.37–$631range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Mvp Medicaid 1712, Mvp 2900 | Mvp Option Medicaid 171201, Mvp Essentia | $29.61 |
| Excellus Medicaid 1706, Excellus Blue Cross Blue Shield 2201 | Blue Ch | $30.09 |
| Highmark Blue Cross Blue Shield Of Western NY Medicare 1301 | Highmark | $32.39 |
| Capital District Physicians (Cdphp) Medicaid 1704 | Capital District P | $32.39 |
| Aetna Medicare 1300, Aetna 2700 | Aetna Medicare 130001, Aetna Senior | $33.29 |
| Excellus Blue Cross Blue Shield 2201 | Excellus Metal Tiers 220102, Un | $33.29 |
| Medicare Blue Choice 1306 | Medicare Blue Choice 130601, Blue Medicare | $33.29 |
| Molina Medicaid 1723, Molina Healthcare 5189 | Molina Medicaid 172301, | $34.16 |
| Fidelis Medicaid 1708, Fidelis 5155 | Fidelis Medicaid 170801, Fidelis | $34.91 |
| Medicare Blue Choice 1306 | Univera Senior Choice Medicare 130603 | $35.84 |
| Mvp 2900 | Mvp Premier Individual 290002, Mvp Premier Group 290003 | $36.22 |
| Mvp Medicare 1307, Mvp Medicare Dual Access Dsnp 1321 | Mvp Medicare 1 | $36.27 |
| Fidelis Medicaid 1708, Fidelis 5155 | Fidelis Essential (W/ Medicaid) | $36.66 |
| Empire Plan 5179, Empire Plan UHC 5180 | Empire Plan 517901, Empire Pl | $38.28 |
| Amerigroup (Blue Cross Blue Shield Wny Alternate) 1720 | Amerigroup (B | $38.73 |
| Aetna 2700 | Aetna Chickering 270001,Aetna 270002,Aetna Ur 270003,Aetn | $41.04 |
| Highmark Blue Cross Blue Shield Of Western NY Medicaid 1702, Highmark | $41.15 |
| Lifetime Benefit Solutions 2200,Excellus Blue Cross Blue Shield 2201,O | $46.72 |
| Fidelis 5155 | Fidelis Metal Tiers 515501 | $47.13 |
| Umr 5142, Pomco Ins Co 5157, United Healthcare 5158 | Umr 514201, Pomc | $47.81 |
| Highmark Blue Cross Blue Shield Of Western NY Medicaid 1702, Amerigrou | $48.41 |
| Independent Health 5156 | Independent Health (Buffalo NY) 515601,Nova | $49.84 |
| Mvp 2900, Cigna 5144 | Mvp Commercial Non PPO Fully Insured 290001, Mv | $49.99 |
| Capital District Physicians Health Plan (Cdphp) 5149 | Capital Distric | $90.62 |
| Cdphp Medicare 1320 | Cdphp Medicare 132001 | $162 |
| Medicare Blue Choice 1306 | Medicare Blue Choice 130601 | $218 |
| Aetna Medicare 1300 | Aetna Medicare 130001 | $266 |
| Humana Medicare 1312 | Humana Medicare 131201 | $266 |
| United Healthcare Medicare 1309 | United Healthcare Medicare 130901 | $266 |
| Wellcare Medicare 1310 | Wellcare Medicare 131001 | $266 |
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