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
DIP,PERT(A)TET-HEPB-POLIO-HIB PED(PF) 15-5 UNIT-10 MCG/0.5 ML IM SYRNG
Low
$0
Average
$264
Median
$192
High
$1.4k
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
367 hospitals; the 90th percentile is 3.5× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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481 hospital rates
iThe hospitals that file a Blue Cross Blue Shield 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 | Mayo Clinic Rochester, MN professional · percent of total billed charges · outpatientfrom % of charges | 10 | $196 | $201 | $10 | 5% | 370–388 | $192 – $218 |
| 2 | Mayo Clinic Health System Mankato 56001-4752 professional · percent of total billed charges · outpatientfrom % of charges | 8 | $157 | $158 | $9 | 5% | 301–328 | $148 – $174 |
| 3 | Mayo Clinic Health System Owatonna 55060-5503 professional · percent of total billed charges · outpatientfrom % of charges | 8 | $157 | $158 | $9 | 5% | 275–293 | $148 – $174 |
| 4 | FHN Memorial Hospital Freeport, IL percent of total billed charges · outpatientfrom % of charges | 1 | $152 | $152 | $135 | 89% | 137 | $16 – $287 |
| 5 | Mayo Clinic Health System Eau Claire 54703-5270 professional · fee schedule · outpatient | 1 | $174 | $174 | — | — | 71 | $174 – $174 |
| 6 | Mayo Clinic Health System St, NE professional · percent of total billed charges · outpatientfrom % of charges | 6 | $139 | $147 | $19 | 13% | 51 | $128 – $174 |
| 7 | Mayo Clinic Health System Eau Claire 54703-5270 professional · percent of total billed charges · outpatientfrom % of charges | 4 | $167 | $167 | $5 | 3% | 45 | $162 – $174 |
| 8 | Children's Healthcare of Atlanta Atlanta, GA percent of total billed charges · outpatientfrom % of charges | 3 | $65 | $77 | $17 | 22% | 41 | $65 – $101 |
| 9 | PRISMA HEALTH BAPTIST EASLEY HOSPITAL EASLEY, SC percent of total billed charges · bothfrom % of charges | 3 | $122 | $154 | $59 | 39% | 40–49 | $102 – $237 |
| 10 | PRISMA HEALTH GREENVILLE MEMORIAL HOSPITAL GREENVILLE, SC percent of total billed charges · bothfrom % of charges | 3 | $122 | $154 | $59 | 39% | 40–49 | $102 – $237 |
| 11 | Mayo Clinic Health System Bloomer, WI facility · percent of total billed charges · bothfrom % of charges | 3 | $153 | $140 | $40 | 29% | 35 | $57 – $171 |
| 12 | Mayo Clinic Health System Sparta, WI professional · percent of total billed charges · outpatientfrom % of charges | 7 | $162 | $163 | $8 | 5% | 33–42 | $148 – $174 |
| 13 | Mayo Clinic Health System Menomonie, WI facility · percent of total billed charges · bothfrom % of charges | 3 | $153 | $138 | $43 | 31% | 31 | $50 – $171 |
| 14 | Mayo Clinic Health System Sparta, WI professional · fee schedule · outpatient | 1 | $174 | $174 | — | — | 19 | $174 – $174 |
| 15 | Mayo Clinic Health System Barron, WI facility · percent of total billed charges · bothfrom % of charges | 3 | $153 | $138 | $43 | 31% | 19 | $51 – $171 |
| 16 | PRISMA HEALTH BAPTIST PARKRIDGE HOSPITAL COLUMBIA, SC percent of total billed charges · bothfrom % of charges | 2 | $205 | $205 | $42 | 21% | 17–26 | $162 – $247 |
| 17 | PRISMA HEALTH RICHLAND HOSPITAL COLUMBIA, SC percent of total billed charges · bothfrom % of charges | 2 | $205 | $205 | $42 | 21% | 17–26 | $162 – $247 |
| 18 | Mayo Clinic Health System Lake City 55041-1143 facility · percent of total billed charges · bothfrom % of charges | 11 | $156 | $149 | $22 | 15% | 13–31 | $99 – $171 |
| 19 | PRISMA HEALTH OCONEE MEMORIAL HOSPITAL SENECA, SC percent of total billed charges · bothfrom % of charges | 3 | $47 | $104 | $87 | 83% | 2–20 | $39 – $227 |
| 20 | St Louis Childrens Hospital Saint Louis, MO fee schedule · both | 2 | $836 | $836 | $174 | 21% | 2–20 | $663 – $1.0k |
| 21 | Arkansas Childrens Hospital Little Rock, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $157 | $157 | — | — | 1–10 | $157 – $157 |
| 22 | EATON RAPIDS MEDICAL CENTER Eaton Rapids, MI percent of total billed charges · outpatientfrom % of charges | 3 | $138 | $125 | $17 | 13% | 1–10 | $98 – $138 |
| 23 | MVHS, Inc. Utica, NY fee schedule · both | 1 | $164 | $164 | — | — | 1–10 | $164 – $164 |
| 24 | Mayo Clinic Arizona Phoenix, AZ professional · percent of total billed charges · outpatientfrom % of charges | 5 | $164 | $172 | $14 | 8% | 1–10 | $164 – $197 |
| 25 | Mayo Clinic Health System Saint James 56081-5550 facility · percent of total billed charges · bothfrom % of charges | 7 | $148 | $142 | $23 | 16% | 1–10 | $83 – $169 |
← Payers reporting CPT 90697 · Snapshot 20261111T120946Z-9134e7f7