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
DIPH,PERTUS(ACEL),TET PED (DTAP) 25-58-10 LF-MCG-LF/0.5ML IM SYRG [19451]
Low
$0
Average
$113
Median
$50
High
$8.8k
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
928 hospitals; the 90th percentile is 5.2× 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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1,315 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 | West Virginia University Hospitals, Inc. Morgantown, WV facility · percent of total billed charges · outpatientfrom % of charges | 2 | $40 | $40 | — | — | 244–271 | $40 – $40 |
| 2 | City Hospital, Inc. Martinsburg, WV facility · percent of total billed charges · outpatientfrom % of charges | 2 | $42 | $42 | — | — | 114–141 | $42 – $42 |
| 3 | Mercy Hospital Southeast Girardeau, MO professional · fee schedule · outpatient | 3 | $28 | $28 | $6 | 23% | 84–102 | $22 – $34 |
| 4 | Mishawaka Medical Center Mishawaka, IN professional · fee schedule · both | 1 | $41 | $41 | — | — | 22–103 | $41 – $41 |
| 5 | Mayo Clinic Rochester, MN professional · percent of total billed charges · outpatientfrom % of charges | 10 | $35 | $36 | $2 | 5% | 21–30 | $34 – $39 |
| 6 | St Peters Hospital Albany, NY professional · percent of total billed charges · outpatientfrom % of charges | 1 | $47 | $47 | — | — | 20–47 | $47 – $47 |
| 7 | Mayo Clinic Health System Owatonna 55060-5503 professional · percent of total billed charges · outpatientfrom % of charges | 9 | $34 | $30 | $11 | 38% | 18 | $6 – $39 |
| 8 | NYU Langone Mineola, NY percent of total billed charges · outpatientfrom % of charges | 50 | $134 | $132 | $7 | 5% | 14–32 | $107 – $134 |
| 9 | Mayo Clinic Health System Mankato 56001-4752 professional · percent of total billed charges · outpatientfrom % of charges | 9 | $34 | $30 | $11 | 38% | 12 | $6 – $39 |
| 10 | NYU Langone Brooklyn, NY percent of total billed charges · outpatientfrom % of charges | 50 | $127 | $125 | $6 | 5% | 11 | $102 – $127 |
| 11 | Methodist Medical Center of Illinois Peoria, IL percent of total billed charges · outpatientfrom % of charges | 4 | $17 | $17 | $0 | 3% | 6–60 | $16 – $18 |
| 12 | SONORA COMMUNITY HOSPITAL Sonora, CA percent of total billed charges · outpatientfrom % of charges | 2 | $64 | $77 | $45 | 58% | 6–60 | $30 – $137 |
| 13 | Samaritan Hospital Troy, NY professional · percent of total billed charges · outpatientfrom % of charges | 1 | $47 | $47 | — | — | 6–60 | $47 – $47 |
| 14 | DIGNITY HEALTH Merced, CA fee schedule · outpatient | 2 | $35 | $29 | $12 | 43% | 5–50 | $4 – $35 |
| 15 | Duke University Hospital Durham, NC facility · percent of total billed charges · outpatientfrom % of charges | 2 | $56 | $56 | $19 | 34% | 3–30 | $37 – $75 |
| 16 | Duke University Hospital Raleigh, NC facility · percent of total billed charges · outpatientfrom % of charges | 2 | $56 | $56 | $19 | 34% | 3–30 | $37 – $75 |
| 17 | ST JOSEPH'S HOSPITAL AND HEALTH CENTER Dickinson, ND fee schedule · outpatient | 3 | $32 | $39 | $14 | 37% | 3–30 | $27 – $74 |
| 18 | Carle BroMenn Medical Center Normal, IL other · outpatient | 1 | $17 | $17 | — | — | 2–20 | $17 – $17 |
| 19 | Children's Healthcare of Atlanta Atlanta, GA percent of total billed charges · outpatientfrom % of charges | 3 | $10 | $12 | $3 | 22% | 2–20 | $10 – $16 |
| 20 | Community Health Association Ripley, WV facility · percent of total billed charges · outpatientfrom % of charges | 1 | $66 | $66 | — | — | 2–20 | $66 – $66 |
| 21 | Eisenhower Medical Center Rancho Mirage, CA percent of total billed charges · inpatientfrom % of charges | 3 | $57 | $51 | $8 | 15% | 2–20 | $40 – $57 |
| 22 | FHN Memorial Hospital Freeport, IL percent of total billed charges · outpatientfrom % of charges | 1 | $32 | $32 | $16 | 49% | 2–20 | $16 – $47 |
| 23 | GOOD SAMARITAN HOSPITAL Kearney, NE fee schedule · outpatient | 2 | $16 | $16 | $2 | 14% | 2–20 | $14 – $18 |
| 24 | Harrison Community Hospital, Inc. Cadiz, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $56 | $56 | — | — | 2–20 | $56 – $56 |
| 25 | MERCY MEDICAL CENTER Williston, ND fee schedule · outpatient | 3 | $44 | $45 | $12 | 26% | 2–20 | $32 – $62 |
← Payers reporting CPT 90700 · Snapshot 20261111T120946Z-9134e7f7