IV fluids, first hour at Intermountain Health Good Samaritan Medical Center. CPT 96360.
What Intermountain Health Good Samaritan Medical Center publishes for this service, straight from its standard-charges file, last updated March 22, 2026.
Outpatient / ER
—cash price (self-pay)
$665list price
$50.00–$596range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $123 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $153 |
| Kaiser Perm HMO | Kaiser Out Of State | $153 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $153 |
| Kaiser Perm PPO/POS | Kaiser Perm PPO/POS | $155 |
| Allegiance | Cigna Sclhs Employees | $166 |
| Cigna Scl Employees | Cigna Sclhs Cdhp | $166 |
| Cigna | Cigna Co Public Option | $169 |
| Cigna | Cigna Connect Exchange | $169 |
| Cigna | Cigna Surefit | $169 |
| Aetna | Aetna Colorado Preferred | $247 |
| BCBS/Anthem | BCBS Co Federal | $264 |
| BCBS/Anthem | BCBS Co HMO | $264 |
| BCBS/Anthem | BCBS Co PPO | $264 |
| Aetna | Aetna HMO/EPO | $265 |
| Aetna | Aetna Indemnity | $265 |
| Aetna | Aetna Other | $265 |
| Aetna | Aetna POS/Qpos | $265 |
| Aetna | Aetna PPO | $265 |
| Aetna | Aetna Src | $265 |
| Geha | Geha-Asa | $265 |
| Choicecare Humana | Choicecare Humana HMO EPO | $279 |
| Choicecare Humana | Choicecare Humana PPO | $279 |
| Cigna | Cigna HMO | $380 |
| Cigna | Cigna Indemnity | $380 |
| Cigna | Cigna Local Plus | $380 |
| Cigna | Cigna Other | $380 |
| Cigna | Cigna POS/Qpos | $380 |
| Cigna | Cigna PPO | $380 |
| Cigna | Eighth Dist Elect Ben Pln | $380 |
Inpatient
—cash price (self-pay)
$665list price
$196–$665range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $196 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $280 |
| Kaiser Perm HMO | Kaiser Out Of State | $280 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $280 |
| Kaiser Self Funded | Kaiser Self Funded | $280 |
| Kaiser Perm PPO/POS | Kaiser Perm PPO/POS | $289 |
| Private Hlthcare Sys | Phcs Other | $498 |
| Private Hlthcare Sys | Phcs PPO | $498 |
| BCBS/Anthem | BCBS Co Indemnity | $559 |
| Multiplan Inc | Multiplan Inc Other | $565 |
| Multiplan Inc | Multiplan Inc PPO | $565 |
| Aetna | Aetna Nap | $596 |
| Cigna | Cigna HMO | $665 |
| Cigna | Cigna Indemnity | $665 |
| Cigna | Cigna Local Plus | $665 |
| Cigna | Cigna Other | $665 |
| Cigna | Cigna POS/Qpos | $665 |
| Cigna | Cigna PPO | $665 |
| Cigna | Eighth Dist Elect Ben Pln | $665 |
| Cigna | Health-Partners | $665 |
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All common services at Intermountain Health Good Samaritan Medical Center