IV push, single drug at WellSpan Good Samaritan Hospital. CPT 96374.
What WellSpan Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$421cash price (self-pay)
$526list price
$38.78–$758range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $38.78 |
| Geisinger_Medicaid | All_Plans | $38.78 |
| Health_Partners_Medicaid | All_Other_Plans | $38.78 |
| PA_Health_&_Wellness_Medicaid | All_Plans | $38.78 |
| UPMC_Medicaid | All_Plans | $38.78 |
| Amerihealth_Caritas_Medicaid | All_Plans | $44.05 |
| Aetna_Better_Health_Kids | All_Plans | $105 |
| Blue_Cross | Capital_Blue_Performance_PPO | $177 |
| Blue_Cross_BlueJourney_Medicare | All_Plans | $208 |
| Highmark_Medicare | All_Plans | $210 |
| Aetna_Advantra_Medicare | All_Plans | $214 |
| Aetna_Medicare | All_Plans | $214 |
| Blue_Cross | Capital_Cares_4_kids | $215 |
| Geisinger_Gold_Medicare | All_Plans | $219 |
| Devoted_Medicare | All_Plans | $219 |
| United_Medicare | ISNP_DSNP_Plans | $219 |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $219 |
| Amerihealth_Medicare | All_Plans | $220 |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $220 |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $220 |
| Jefferson_Health_Medicare_Advantage | All_Plans | $225 |
| PA_Health_&_Wellness_Medicare | All_Plans | $225 |
| Blue_Cross | Capital_Blue_Cross_Healthy_Benefits_PPO | $246 |
| Blue_Cross | All_Other_Plans | $307 |
| WellSpan_Capital_Blue_Cross | All_Plans | $316 |
| Geisinger | All_Plans | $316 |
| UPMC | UPMC_For_Kids | $316 |
| UPMC | Employees_And_Dependents | $316 |
| Highmark | Higmark_Healthy_Kids | $323 |
| Cigna | All_Plans | $336 |
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