Combined vaccine for diphtheria, tetanus, whooping cough, hepatitis B, and polio

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

Pediarix PFS

Payers reporting CPT 90723

Payer pricing summary

Low

Average

$180

Median

$147

High

$719

Payer rate distribution

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#
1	Wellmark fee schedule · outpatient · +17 other terms	24	$104	$102	$6	6%	424	$68 – $104
2	Blue Cross Blue Shield fee schedule · outpatient · +33 other terms	244	$208	$241	$146	60%	4–40	$0 – $666
3	Anthem fee schedule · outpatient · +23 other terms	93	$123	$166	$132	79%	4–40	$3 – $1.2k
4	UnitedHealthcare fee schedule · outpatient · +29 other terms	463	$204	$198	$124	63%	1–10	$0 – $1.3k
5	Cigna fee schedule · outpatient · +23 other terms	261	$177	$313	$209	67%	—	$0 – $1.2k
6	Humana fee schedule · outpatient · +23 other terms	174	$107	$343	$752	219%	—	$9 – $8.3k
7	Aetna fee schedule · outpatient · +29 other terms	120	$120	$337	$814	241%	—	$0 – $8.4k
8	MultiPlan fee schedule · outpatient · +19 other terms	47	$279	$419	$356	85%	—	$4 – $1.5k
9	Medica fee schedule · outpatient · +17 other terms	41	$189	$204	$87	43%	—	$31 – $430
10	Molina facility · case rate · outpatient · +25 other terms	37	$20	$16	$7	43%	—	$6 – $36
11	Tricare facility · fee schedule · outpatient · +17 other terms	33	$70	$74	$91	122%	—	$0 – $359
12	Caresource fee schedule · outpatient · +15 other terms	30	$110	$105	$2	2%	—	$99 – $110
13	Amerihealth Caritas facility · fee schedule · outpatient · +15 other terms	27	$12	$15	$9	63%	—	$10 – $55
14	Highmark facility · fee schedule · outpatient · +18 other terms	25	$12	$184	$228	123%	—	$11 – $1.0k
15	Regence facility · fee schedule · both · +15 other terms	24	$104	$135	$66	49%	—	$48 – $336
16	Bcbs Tx fee schedule · outpatient · +4 other terms	23	$409	$394	$112	28%	—	$64 – $631
17	Premera facility · fee schedule · both · +9 other terms	23	$104	$135	$65	48%	—	$59 – $336
18	Carefirst facility · fee schedule · both · +12 other terms	22	$104	$136	$64	47%	—	$104 – $336
19	Excellus facility · fee schedule · both · +13 other terms	22	$104	$131	$59	45%	—	$104 – $336
20	Kaiser fee schedule · outpatient · +20 other terms	18	$310	$279	$220	79%	—	$3 – $1.3k
21	First Health fee schedule · outpatient · +19 other terms	17	$532	$511	$241	47%	—	$0 – $986
22	Medicaid fee schedule · outpatient · +15 other terms	17	$149	$199	$287	144%	—	$1 – $1.3k
23	Bcbs La fee schedule · outpatient · +2 other terms	16	$111	$110	$4	3%	—	$102 – $117
24	Aetna Better Health facility · fee schedule · outpatient · +14 other terms	15	$17	$27	$32	116%	—	$10 – $170
25	Beechstreet percent of total billed charges · inpatientfrom % of charges · +2 other terms	15	$195	$258	$177	69%	—	$102 – $689

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