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
$17
Average
$71
Median
$40
High
$337
Each hospital's average Devoted rate, under the methodology and billing class chosen below.
45 hospitals; the 90th percentile is 5.0× 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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52 hospital rates
iThe hospitals that file a Devoted 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 | Boulder Community Health Lafayette, CO facility · percent of total billed charges · inpatientfrom % of charges | 1 | $40 | $40 | — | — | — | $40 – $40 |
| 2 | Boulder Community Health Lafayette, CO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $40 | $40 | — | — | — | $40 – $40 |
| 3 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · percent of total billed charges · inpatientfrom % of charges | 1 | $478 | $478 | — | — | — | $478 – $478 |
| 4 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $259 | $259 | $219 | 84% | — | $40 – $478 |
| 5 | CATHOLIC HEALTH INITIATIVES COLORADO Canon City, CO percent of total billed charges · outpatientfrom % of charges | 1 | $24 | $23 | $1 | 5% | — | $22 – $24 |
| 6 | Clarion Hospital Clarion, PA facility · percent of total billed charges · inpatientfrom % of charges | 1 | $478 | $478 | — | — | — | $478 – $478 |
| 7 | Clarion Hospital Clarion, PA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $259 | $259 | $219 | 84% | — | $40 – $478 |
| 8 | Dukes Health System LLC Peru, IN facility · fee schedule · outpatient | 1 | $45 | $38 | $22 | 58% | — | $8 – $67 |
| 9 | Hancock County Hospital SNEEDVILLE, TN percent of total billed charges · bothfrom % of charges | 1 | $171 | $171 | — | — | — | $171 – $171 |
| 10 | Honokaa Hospital and Skilled Nursing Facility Honokaa, HI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 11 | Johnson County Community Hospital MOUNTAIN CITY, TN percent of total billed charges · bothfrom % of charges | 1 | $116 | $116 | — | — | — | $116 – $116 |
| 12 | Kau Hospital Pahala, HI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $24 | $24 | — | — | — | $24 – $24 |
| 13 | Kauai Veterans Memorial Hospital Waimea, HI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $90 | $90 | — | — | — | $90 – $90 |
| 14 | Kohala Hospital Kapaau, HI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $133 | $133 | $0 | 0% | — | $133 – $133 |
| 15 | Lancaster General Health Lancaster, PA facility · other · outpatient | 1 | $27 | $27 | — | — | — | $27 – $27 |
| 16 | MARYMOUNT HOSPITAL INC Garfield Heights, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $100 | $101 | $34 | 34% | — | $66 – $137 |
| 17 | MID-VALLEY HEALTHCARE INC Lebanon, OR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $19 | $30 | $24 | 81% | — | $7 – $63 |
| 18 | Mercy Hospital Aurora Aurora, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 19 | Mercy Hospital Berryville Berryville, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 20 | Mercy Hospital Booneville Booneville, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $41 | $41 | — | — | — | $41 – $41 |
| 21 | Mercy Hospital Carthage Carthage, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $54 | $54 | — | — | — | $54 – $54 |
| 22 | Mercy Hospital Healdton Inc Healdton, OK facility · percent of total billed charges · outpatientfrom % of charges | 1 | $64 | $64 | — | — | — | $64 – $64 |
| 23 | Mercy Hospital Ozark Ozark, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 24 | Mercy Hospital Paris Paris, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 25 | Mercy Hospital Tishomingo Inc Tishomingo, OK facility · percent of total billed charges · outpatientfrom % of charges | 1 | $107 | $107 | — | — | — | $107 – $107 |
← Payers reporting CPT 90700 · Snapshot 20261111T120946Z-9134e7f7