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
HCHG IV INJECTION TX/DX/PROPHYLAXIS ADDL SEQUENTIA
Ulm, MN
See all hospitals reporting CPT 96375 →Price type
Allina Health Systems’s median price of $111 is 31% above the median hospital's median price ($85), higher than 60% of the 2,521 hospitals reporting CPT 96375. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 25 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | ||||
|---|---|---|---|---|
| 1 | Ucare ucare pmap (abdmnorsuv) facility · percent of total billed charges · outpatientfrom % of charges | $33.04 | $31.66 | $28.85 – $33.10 |
| 2 | Aetna allina aetna medicare (n) facility · fee schedule · outpatient | $45.85 | $45.85 | $45.85 – $45.85 |
| 3 | Medicare medicare (n) facility · fee schedule · outpatient | $48.26 | $48.26 | $48.26 – $48.26 |
| 4 | Medica medica pmap (n) facility · percent of total billed charges · outpatientfrom % of charges | $52.22 | $50.04 | $45.60 – $52.31 |
| 5 | Bcbs Mn bc pmap (n) facility · other · outpatient | $66.59 | $66.59 | $66.59 – $66.59 |
| 6 | Medicaid medicaid ma (n) facility · other · outpatient | $71.88 | $68.89 | $62.77 – $72.01 |
| 7 | Medica medica medicare (r) facility · fee schedule · outpatient | $72.95 | $69.91 | $63.70 – $73.09 |
| 8 | Medica medica dual solutions (r) facility · percent of total billed charges · outpatientfrom % of charges | $73.89 | $70.82 | $64.53 – $74.03 |
| 9 | Blue Cross Blue Shield bc medicare (n) facility · fee schedule · outpatient | $76.35 | $73.17 | $66.67 – $76.49 |
| 10 | Aetna aetna elevate (n r) facility · percent of total billed charges · inpatientfrom % of charges | $100.61 | $96.42 | $87.86 – $100.79 |
| 11 | Aetna aetna elevate (n r) facility · percent of total billed charges · outpatientfrom % of charges | $101.61 | $97.38 | $88.74 – $101.79 |
| 12 | Aetna aetna performance (n r) facility · percent of total billed charges · inpatientfrom % of charges | $108.68 | $104.16 | $94.92 – $108.88 |
| 13 | Aetna aetna performance (n r) facility · percent of total billed charges · outpatientfrom % of charges | $109.77 | $105.20 | $95.86 – $109.97 |
| 14 | Medica medica ubh (n) facility · percent of total billed charges · inpatientfrom % of charges | $114.94 | $110.16 | $100.38 – $115.15 |
| 15 | Medica medica ubh pmap (n) facility · percent of total billed charges · outpatientfrom % of charges | $131.36 | $125.89 | $114.72 – $131.60 |
| 16 | Cigna hpi cigna (n) facility · other · outpatient | $134.28 | $128.69 | $117.27 – $134.53 |
| 17 | First Health first health (abdmnosurv) facility · percent of total billed charges · inpatientfrom % of charges | $137.93 | $132.19 | $120.46 – $138.18 |
| 18 | First Health first health (abdmnosurv) facility · percent of total billed charges · outpatientfrom % of charges | $137.93 | $132.19 | $120.46 – $138.18 |
| 19 | Medica medica ubh (n) facility · percent of total billed charges · outpatientfrom % of charges | $137.93 | $132.19 | $120.46 – $138.18 |
| 20 | Aetna aetna direct/indirect network (n r) facility · percent of total billed charges · inpatientfrom % of charges | $138.88 | $133.10 | $121.29 – $139.13 |
| 21 | Aetna aetna direct/indirect network (n r) facility · percent of total billed charges · outpatientfrom % of charges | $140.28 | $134.44 | $122.51 – $140.53 |
| 22 | Bcbs Mn bc state health plan (n) facility · other · outpatient | $164.47 | $164.47 | $164.47 – $164.47 |
| 23 | Bcbs Mn bc premier(n) facility · other · outpatient | $211.31 | $211.31 | $211.31 – $211.31 |
| 24 | Blue Cross Blue Shield bc aehp (n) facility · other · outpatient | $248.58 | $248.58 | $248.58 – $248.58 |
| 25 | Bcbs Mn bc high value/performance network (n) facility · other · outpatient | $266.83 | $266.83 | $266.83 – $266.83 |
Last updated: Jun 16, 2026
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