Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC
Low
$65
Average
$108
Median
$90
High
$168
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7 hospital rates
iThe hospitals that file a Bcbs Mi rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Emma L Bixby Medical Center Adrian, MI facility · other · outpatient | 2 | $44 | $44 | — | — | 1–10 | $44 – $44 |
| 2 | Mercy Memorial Hospital Corporation Monroe, MI facility · other · outpatient | 1 | $55 | $55 | — | — | 1–10 | $55 – $55 |
| 3 | Emma L Bixby Medical Center Adrian, MI professional · fee schedule · outpatient | 3 | $63 | $79 | $23 | 29% | — | $63 – $111 |
| 4 | Mercy Memorial Hospital Corporation Monroe, MI professional · fee schedule · outpatient | 2 | $108 | $108 | $7 | 6% | — | $101 – $114 |
| 5 | The Toledo Hospital Maumee, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $146 | $146 | — | — | — | $146 – $146 |
| 6 | The Toledo Hospital Maumee, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $146 | $146 | — | — | — | $146 – $146 |
| 7 | The Toledo Hospital Maumee, OH professional · fee schedule · outpatient | 2 | $190 | $190 | — | — | — | $190 – $190 |
← Payers reporting CPT 96376 · Snapshot 20261111T120946Z-9134e7f7