DTaP vaccine, intramuscular injection

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

DIPH,PERTUS(ACEL),TET PED (DTAP) 25-58-10 LF-MCG-LF/0.5ML IM SYRG [19451]

Payers reporting CPT 90700

Payer pricing summary

Low

Average

$82

Median

$65

High

$300

Payer rate distribution

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#
1	Blue Cross Blue Shield fee schedule · outpatient · +34 other terms	314	$57	$70	$55	79%	13–130	$0 – $719
2	Anthem fee schedule · outpatient · +25 other terms	105	$37	$57	$54	95%	10–100	$3 – $313
3	UnitedHealthcare fee schedule · outpatient · +31 other terms	514	$60	$63	$34	54%	8–80	$0 – $461
4	Molina fee schedule · both · +30 other terms	44	$37	$39	$15	39%	2–20	$10 – $93
5	Cigna fee schedule · outpatient · +28 other terms	292	$57	$92	$59	65%	—	$0 – $313
6	Humana fee schedule · outpatient · +23 other terms	187	$31	$152	$666	438%	—	$1 – $8.3k
7	Aetna fee schedule · outpatient · +31 other terms	158	$37	$141	$610	432%	—	$0 – $8.4k
8	MultiPlan fee schedule · outpatient · +20 other terms	75	$101	$132	$136	102%	—	$4 – $896
9	Medica fee schedule · outpatient · +18 other terms	56	$66	$79	$56	70%	—	$15 – $250
10	Amerihealth Caritas facility · fee schedule · outpatient · +16 other terms	39	$12	$15	$10	65%	—	$10 – $55
11	Highmark facility · fee schedule · outpatient · +18 other terms	36	$13	$36	$29	81%	—	$11 – $152
12	Caresource fee schedule · outpatient · +18 other terms	32	$32	$35	$6	17%	—	$1 – $37
13	Regence facility · fee schedule · both · +17 other terms	29	$31	$42	$21	50%	—	$14 – $118
14	Kaiser fee schedule · outpatient · +21 other terms	27	$77	$81	$69	85%	—	$1 – $452
15	Premera facility · fee schedule · both · +14 other terms	27	$30	$41	$20	48%	—	$18 – $96
16	Wellmark facility · fee schedule · both · +18 other terms	27	$30	$38	$18	48%	—	$12 – $96
17	Baylor Scott White Health Plan facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	26	$104	$93	$15	17%	—	$68 – $118
18	Carefirst facility · fee schedule · both · +13 other terms	26	$30	$41	$19	48%	—	$30 – $96
19	Excellus facility · fee schedule · both · +13 other terms	26	$30	$39	$18	46%	—	$30 – $96
20	Medicaid facility · fee schedule · outpatient · +16 other terms	26	$24	$22	$5	25%	—	$6 – $26
21	First Health fee schedule · outpatient · +19 other terms	24	$96	$101	$55	54%	—	$0 – $272
22	Bcbs Tx fee schedule · outpatient · +4 other terms	22	$122	$115	$35	31%	—	$27 – $188
23	Tricare fee schedule · both · +17 other terms	21	$30	$31	$2	8%	—	$30 – $44
24	Bcbs La fee schedule · outpatient · +2 other terms	17	$32	$32	$1	3%	—	$30 – $33
25	Aetna Better Health facility · fee schedule · outpatient · +14 other terms	15	$17	$23	$15	68%	—	$10 – $49

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