Flu vaccine, trivalent split virus, 0.25 mL intramuscular dose

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

HC Iiv3 Vaccine Split Virus 0.25 Ml Dosage Im Use

Medicaid pricing summary

Low

Average

$17

Median

$17

High

$41

Medicaid rate distribution

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25 hospital rates

#		Plans
1	ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27
2	ADVENTIST HEALTH MENDOCINO COAST Bragg, CA fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27
3	Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · case rate · outpatient	1	$10	$10	—	—	—	$10 – $10
4	CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient	1	$11	$11	—	—	—	$11 – $11
5	Childrens Hospital of Los Angeles Angeles, CA facility · other · outpatient	2	$10	$10	—	—	—	$10 – $10
6	Childrens Hospital of Los Angeles Angeles, CA professional · fee schedule · outpatient	2	$2	$2	—	—	—	$2 – $2
7	Clarion Hospital Clarion, PA facility · case rate · outpatient	1	$10	$10	—	—	—	$10 – $10
8	Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient	1	$19	$19	—	—	—	$19 – $19
9	Greater Baltimore Medical Center Towson, MD professional · fee schedule · both	1	$6	$6	—	—	—	$6 – $6
10	HMA Santa Rosa Medical Center LLC Milton, FL facility · fee schedule · outpatient	1	$19	$19	—	—	—	$19 – $19
11	Hospital Authority of Colquitt County Moultrie, GA fee schedule · both	1	$17	$17	—	—	—	$17 – $17
12	INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · case rate · outpatient	1	$19	$19	—	—	—	$19 – $19
13	LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA fee schedule · outpatient	1	$42	$41	$11	27%	—	$27 – $54
14	Mercy Hospitals East Communities Washington, MO professional · fee schedule · inpatient	1	$17	$17	—	—	—	$17 – $17
15	Mercy Hospitals East Communities Washington, MO professional · fee schedule · outpatient	1	$17	$17	—	—	—	$17 – $17
16	NYU Langone Mineola, NY fee schedule · outpatient	15	$6	$6	—	—	—	$6 – $6
17	NYU Langone Brooklyn, NY fee schedule · outpatient	15	$6	$6	—	—	—	$6 – $6
18	NYU Langone New York, NY fee schedule · outpatient	15	$6	$6	—	—	—	$6 – $6
19	NYU Langone Hospital?Suffolk Patchogue, NY fee schedule · outpatient	15	$6	$6	—	—	—	$6 – $6
20	REEDLEY COMMUNITY HOSPITAL Reedley, CA fee schedule · outpatient	1	$27	$27	$1	2%	—	$26 – $27
21	SONORA COMMUNITY HOSPITAL Sonora, CA fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27
22	Ste. Genevieve County Memorial Hospital Ste. Genevieve, MO percent of total billed charges · outpatientfrom % of charges	1	$7	$7	—	—	—	$7 – $7
23	UKIAH ADVENTIST HOSPITAL Ukiah, CA fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27
24	WHITE MEMORIAL MEDICAL CENTER MONTEBELLO, CA fee schedule · outpatient	1	$33	$33	—	—	—	$33 – $33
25	WILLITS HOSPITAL INC Willits, CA fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27

← Payers reporting CPT 90657 · Snapshot 20261113T090226Z-3ce6c0b8

CPT 90657