IV push, single drug at Pennsylvania Hospital. CPT 96374.
What Pennsylvania Hospital publishes for this service, straight from its standard-charges file, last updated March 20, 2026.
Outpatient / ER
$528cash price (self-pay)
$1,297list price
$20.87–$1,297range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| PA Medical Assistance | Medicaid | $31.02 |
| Managed Medicaid Other | Managed Medicaid Other | $31.02 |
| PA Health and Wellness Medicaid | PA Health and Wellness Medicaid | $35.67 |
| Keystone Mercy Health Plan | Keystone Mercy Health Plan | $39.71 |
| UPMC | UPMC Medicaid | $52.72 |
| UnitedHealthcare Community (fka AmeriChoice MA) | UnitedHealthcare Com | $61.11 |
| TriCare | TriCare | $224 |
| Horizon NJ Health | Horizon NJ Health | $228 |
| US Family Health Plan | US Family Health Plan | $257 |
| UnitedHealthcare | UnitedHealthcare Compass Exchange | $266 |
| PGM - Regie de l'assurance Maladie Quebec | PGM - Regie de lassurance | $298 |
| Preferred Health Care Eliance | Preferred Health Care Eliance | $337 |
| PGM - Kuwait Defense | PGM - Kuwait Defense | $454 |
| Qualcare | Qualcare | $493 |
| UnitedHealthcare New Business | UnitedHealthcare New Business | $503 |
| Wissahickon Hospice | Wissahickon Hospice | $519 |
| Pgm - Chop | Pgm - Chop | $519 |
| IBC Commercial HPN | IBC Commercial HPN | $522 |
| UnitedHealthcare Non Options | UnitedHealthcare Non Options | $524 |
| Independence Blue Cross | IBC Traditional | $532 |
| Independence Blue Cross/Personal Choice | Personal Choice-IBC PPO | $535 |
| Keystone HMO Proactive | Keystone HMO Proactive | $535 |
| Independence Blue Cross/Keystone Health Plan East | Keystone Health Pl | $535 |
| Olympus | Olympus | $630 |
| URN-Cancer Resource Services | URN-Cancer Resource Services | $649 |
| Horizon Blue Cross of New Jersey | Horizon Blue Cross of NJ-PPO | $661 |
| PGM - Royal Embassy of Saudi Arabia | PGM - Royal Embassy of Saudi Ara | $778 |
| Horizon Blue Cross of New Jersey | Horizon Blue Cross of NJ-Indemnity | $791 |
| PGM - Ontario Ministry of Health and Long-Term Care (OHIP) | PGM - Ont | $843 |
| PGM - Embassy of Qatar | PGM - Embassy of Qatar | $843 |
Inpatient
$528cash price (self-pay)
$1,297list price
$89.23–$1,297range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Horizon NJ Health | Horizon NJ Health | $219 |
| PGM - Regie de l'assurance Maladie Quebec | PGM - Regie de lassurance | $298 |
| Preferred Health Care Eliance | Preferred Health Care Eliance | $337 |
| Devon | Devon Premier | $493 |
| Pgm - Chop | Pgm - Chop | $519 |
| Coventry | HealthAmerica/Coventry SEPA | $519 |
| PGM - Kuwait Defense | PGM - Kuwait Defense | $584 |
| HealthAmerica/Coventry | HealthAmerica/HealthAssurance | $636 |
| URN-Cancer Resource Services | URN-Cancer Resource Services | $649 |
| First Health Global | First Health Global | $649 |
| Coventry | Coventry of Delaware | $661 |
| PGM - Royal Embassy of Saudi Arabia | PGM - Royal Embassy of Saudi Ara | $778 |
| Health Net | Health Net | $778 |
| PGM - Ontario Ministry of Health and Long-Term Care (OHIP) | PGM - Ont | $843 |
| Preferred Care | Preferred Care | $1,038 |
| PGM - Kuwait Oil | PGM - Kuwait Oil | $1,038 |
| PGM - Kuwait Health Division | PGM - Kuwait Health Division | $1,038 |
| Intergroup | Intergroup | $1,038 |
| Humana Choice Care | Humana Choice Care | $1,038 |
| Health America/CCN | First Health/ Coventry National | $1,038 |
| Devon Health Services Inc | Devon Health Services | $1,038 |
| UPMC | UPMC Medicaid | $1,297 |
| United Behavioral Health | United Behavioral Health | $1,297 |
| Quest Behavioral Health | Quest Behavioral Health | $1,297 |
| Managed Medicaid Other | Managed Medicaid Other | $1,297 |
| International PFS | International PFS | $1,297 |
| Horizon Blue Cross of New Jersey | Horizon Blue Cross of NJ-PPO | $1,297 |
| Horizon Blue Cross of New Jersey | Horizon Blue Cross of NJ-Indemnity | $1,297 |
| Health Partners | Health Partners Medicaid | $1,297 |
| Community Behavioral Health | Community Behavioral Health | $1,297 |
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