IV push, single drug at Intermountain Health Good Samaritan Medical Center. CPT 96374.
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)
$596list price
$110–$551range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $110 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $137 |
| Kaiser Perm HMO | Kaiser Out Of State | $137 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $137 |
| Kaiser Perm PPO/POS | Kaiser Perm PPO/POS | $139 |
| Allegiance | Cigna Sclhs Employees | $149 |
| Cigna Scl Employees | Cigna Sclhs Cdhp | $149 |
| Cigna | Cigna Co Public Option | $152 |
| Cigna | Cigna Connect Exchange | $152 |
| Cigna | Cigna Surefit | $152 |
| Aetna | Aetna Colorado Preferred | $222 |
| BCBS/Anthem | BCBS Co Federal | $237 |
| BCBS/Anthem | BCBS Co HMO | $237 |
| BCBS/Anthem | BCBS Co PPO | $237 |
| Aetna | Aetna HMO/EPO | $238 |
| Aetna | Aetna Indemnity | $238 |
| Aetna | Aetna Other | $238 |
| Aetna | Aetna POS/Qpos | $238 |
| Aetna | Aetna PPO | $238 |
| Aetna | Aetna Src | $238 |
| Geha | Geha-Asa | $238 |
| Choicecare Humana | Choicecare Humana HMO EPO | $250 |
| Choicecare Humana | Choicecare Humana PPO | $250 |
| Cigna | Cigna HMO | $341 |
| Cigna | Cigna Indemnity | $341 |
| Cigna | Cigna Local Plus | $341 |
| Cigna | Cigna Other | $341 |
| Cigna | Cigna POS/Qpos | $341 |
| Cigna | Cigna PPO | $341 |
| Cigna | Eighth Dist Elect Ben Pln | $341 |
Inpatient
—cash price (self-pay)
$596list price
$176–$596range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $176 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $251 |
| Kaiser Perm HMO | Kaiser Out Of State | $251 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $251 |
| Kaiser Self Funded | Kaiser Self Funded | $251 |
| Kaiser Perm PPO/POS | Kaiser Perm PPO/POS | $259 |
| Private Hlthcare Sys | Phcs Other | $447 |
| Private Hlthcare Sys | Phcs PPO | $447 |
| BCBS/Anthem | BCBS Co Indemnity | $502 |
| Multiplan Inc | Multiplan Inc Other | $506 |
| Multiplan Inc | Multiplan Inc PPO | $506 |
| Aetna | Aetna Nap | $534 |
| Cigna | Cigna HMO | $596 |
| Cigna | Cigna Indemnity | $596 |
| Cigna | Cigna Local Plus | $596 |
| Cigna | Cigna Other | $596 |
| Cigna | Cigna POS/Qpos | $596 |
| Cigna | Cigna PPO | $596 |
| Cigna | Eighth Dist Elect Ben Pln | $596 |
| Cigna | Health-Partners | $596 |
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All common services at Intermountain Health Good Samaritan Medical Center