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
$153
Average
$163
Median
$157
High
$220
Each hospital's average Excellus rate, under the methodology and billing class chosen below.
19 hospitals; the 90th percentile is 1.2× 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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26 hospital rates
iThe hospitals that file a Excellus 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 | MVHS, Inc. Utica, NY fee schedule · both | 1 | $164 | $164 | — | — | 25–43 | $164 – $164 |
| 2 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · fee schedule · both | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 3 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA facility · fee schedule · both | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 4 | Central Community Hospital Elkader, IA facility · fee schedule · both | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 5 | Clifton Springs Hospital And Clinic Clifton Springs, NY facility · fee schedule · outpatient | 1 | $154 | $154 | — | — | — | $154 – $154 |
| 6 | Covenant Medical Center Inc Waterloo, IA facility · fee schedule · both | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 7 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · inpatient | 2 | $152 | $152 | $4 | 3% | — | $148 – $157 |
| 8 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · outpatient | 2 | $152 | $152 | $4 | 3% | — | $148 – $157 |
| 9 | Elizabethtown Community Hospital Elizabethtown, NY facility · percent of total billed charges · outpatientfrom % of charges | 3 | $213 | $272 | $91 | 33% | — | $202 – $400 |
| 10 | Elizabethtown Community Hospital Elizabethtown, NY professional · fee schedule · both | 3 | $164 | $169 | $6 | 4% | — | $164 – $178 |
| 11 | MVHS, Inc. Utica, NY percent of total billed charges · bothfrom % of charges | 3 | $359 | $269 | $109 | 41% | — | $143 – $368 |
| 12 | MVHS, Inc. Utica, NY percent of total billed charges · outpatientfrom % of charges | 1 | $139 | $139 | — | — | — | $139 – $139 |
| 13 | Mercy Health Services-Iowa Corp. Mason City, IA facility · fee schedule · both | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 14 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · fee schedule · both | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 15 | Mercy Medical Center - Dubuque Dubuque, IA facility · fee schedule · both | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 16 | Mercy Medical Center - Dyersville Dyersville, IA facility · fee schedule · both | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 17 | Mercy Medical Center - New Hampton New Hampton, IA facility · fee schedule · both | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 18 | Mercy Medical Center - Newton Newton, IA facility · fee schedule · both | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 19 | Mercy Medical Center-Clinton Inc Clinton, IA facility · fee schedule · both | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 20 | Rochester General Hospital Rochester, NY facility · fee schedule · outpatient | 1 | $154 | $154 | — | — | — | $154 – $154 |
| 21 | Samaritan Hospital Troy, NY facility · fee schedule · both | 1 | $180 | $180 | — | — | — | $180 – $180 |
| 22 | Sartori Memorial Hospital Inc Cedar Falls, IA facility · fee schedule · both | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 23 | St. Joseph's Mercy Hospital, Centerville Centerville, IA facility · fee schedule · both | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 24 | St. Joseph's Mercy Hospital, Centerville Centerville, IA professional · fee schedule · inpatient | 2 | $152 | $152 | $4 | 3% | — | $148 – $157 |
| 25 | St. Joseph's Mercy Hospital, Centerville Centerville, IA professional · fee schedule · outpatient | 2 | $152 | $152 | $4 | 3% | — | $148 – $157 |
← Payers reporting CPT 90697 · Snapshot 20261111T120946Z-9134e7f7