Combined DTaP, polio, Hib and hepatitis B vaccine

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

DIP,PERT(A)TET-HEPB-POLIO-HIB PED(PF) 15-5 UNIT-10 MCG/0.5 ML IM SYRNG

Payers reporting CPT 90697

Payer pricing summary

Low

$12

Average

$234

Median

$178

High

$1.8k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	WellCare other · outpatient · +13 other terms	8	$83	$100	$35	35%	4–40	$83 – $196
2	UnitedHealthcare fee schedule · outpatient · +25 other terms	406	$374	$445	$321	72%	3–30	$0 – $2.3k
3	Cigna fee schedule · outpatient · +19 other terms	213	$271	$482	$320	66%	—	$0 – $1.5k
4	Humana fee schedule · outpatient · +19 other terms	126	$161	$184	$85	46%	—	$36 – $487
5	Aetna fee schedule · outpatient · +23 other terms	104	$186	$423	$764	181%	—	$0 – $8.4k
6	Blue Cross Blue Shield fee schedule · outpatient · +24 other terms	103	$210	$280	$245	88%	—	$0 – $1.0k
7	Anthem fee schedule · outpatient · +19 other terms	68	$172	$222	$112	50%	—	$34 – $741
8	Molina facility · case rate · outpatient · +23 other terms	38	$20	$15	$6	42%	—	$6 – $36
9	Caresource fee schedule · outpatient · +10 other terms	28	$166	$89	$63	71%	—	$37 – $166
10	Medica fee schedule · outpatient · +14 other terms	26	$77	$267	$122	46%	—	$33 – $396
11	Tricare facility · fee schedule · outpatient · +14 other terms	24	$0	$165	$251	152%	—	$0 – $776
12	Wellmark fee schedule · outpatient · +11 other terms	20	$157	$157	—	—	—	$157 – $157
13	Medcost percent of total billed charges · outpatientfrom % of charges · +6 other terms	19	$204	$372	$254	68%	—	$101 – $987
14	Highmark fee schedule · outpatient · +11 other terms	18	$209	$210	$64	31%	—	$13 – $313
15	Amerihealth Caritas other · outpatient · +10 other terms	15	$97	$109	$31	28%	—	$83 – $165
16	Premera facility · fee schedule · both · +5 other terms	15	$157	$156	$12	7%	—	$103 – $180
17	Regence facility · fee schedule · both · +7 other terms	15	$157	$158	$8	5%	—	$116 – $180
18	Aetna Better Health fee schedule · outpatient · +12 other terms	14	$99	$84	$80	95%	—	$0 – $163
19	Carefirst facility · fee schedule · both · +6 other terms	14	$157	$159	$7	4%	—	$157 – $180
20	Excellus facility · fee schedule · both · +8 other terms	14	$157	$158	$6	4%	—	$157 – $180
21	Beechstreet percent of total billed charges · outpatientfrom % of charges · +2 other terms	13	$285	$302	$56	19%	—	$275 – $495
22	Optum facility · case rate · outpatient · +14 other terms	13	$9	$10	$4	34%	—	$8 – $18
23	Bcbs Nj fee schedule · outpatient · +4 other terms	12	$151	$151	$2	2%	—	$150 – $155
24	Bcbs Nc fee schedule · both · +3 other terms	11	$150	$155	$18	12%	—	$131 – $169
25	Ucare fee schedule · outpatient · +13 other terms	11	$160	$145	$33	23%	—	$49 – $160

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