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
DIPHPERTUS(ACELL)TETPOLIO (PF) 25 LF-58 MCGM-10 LF/0.5 ML IM SYRINGME
Garrison, ND
See all hospitals reporting CPT 90696 →Price type
Garrison Memorial Hospital’s median price of $68 is 34% below the median hospital's median price ($102), higher than 26% of the 1,548 hospitals reporting CPT 90696. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 14 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Humana medicare|all plans fee schedule · outpatient | $43 | $43 | $5 | 12% | — | $38 – $48 |
| 2 | Medica medicare|all plans fee schedule · outpatient | $43 | $43 | $5 | 12% | — | $38 – $48 |
| 3 | UnitedHealthcare medicare|all plans fee schedule · outpatient | $43 | $43 | $5 | 12% | — | $38 – $48 |
| 4 | Blue Cross Blue Shield medicare|all plans fee schedule · outpatient | $44 | $44 | $5 | 12% | — | $39 – $49 |
| 5 | UnitedHealthcare commercial|all plans fee schedule · inpatient | $64 | $64 | $8 | 12% | — | $56 – $71 |
| 6 | UnitedHealthcare commercial|all plans fee schedule · outpatient | $64 | $64 | $8 | 12% | — | $56 – $71 |
| 7 | Blue Cross Blue Shield commercial|all plans fee schedule · outpatient | $68 | $68 | — | — | — | $68 – $68 |
| 8 | Blue Cross Blue Shield medicaid|all plans fee schedule · outpatient | $75 | $75 | $9 | 12% | — | $66 – $84 |
| 9 | Medica commercial|all plans fee schedule · inpatient | $75 | $75 | $9 | 12% | — | $66 – $84 |
| 10 | Medica commercial|all plans fee schedule · outpatient | $75 | $75 | $9 | 12% | — | $66 – $84 |
| 11 | MultiPlan commercial|all plans fee schedule · inpatient | $78 | $78 | $9 | 12% | — | $68 – $87 |
| 12 | MultiPlan commercial|all plans fee schedule · outpatient | $78 | $78 | $9 | 12% | — | $68 – $87 |
| 13 | Sanford Health Plan commercial|all plans fee schedule · inpatient | $82 | $82 | $10 | 12% | — | $72 – $92 |
| 14 | Sanford Health Plan commercial|all plans fee schedule · outpatient | $82 | $82 | $10 | 12% | — | $72 – $92 |
Last updated: Feb 28, 2026
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