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
HC Iiv3 Vaccine Split Virus 0.25 Ml Dosage Im Use
Low
$4
Average
$43
Median
$11
High
$763
Each hospital's average Premera rate, under the methodology and billing class chosen below.
23 hospitals; the 90th percentile is 3.9× 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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23 hospital rates
iThe hospitals that file a Premera 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 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 2 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 3 | Central Community Hospital Elkader, IA facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 4 | Covenant Medical Center Inc Waterloo, IA facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 5 | Good Samaritan Hospital Puyallup, WA percent of total billed charges · outpatientfrom % of charges | 4 | $4 | $4 | — | — | — | $4 – $4 |
| 6 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · both | 1 | $763 | $763 | — | — | — | $763 – $763 |
| 7 | Mary Bridge Children's Hospital Tacoma, WA percent of total billed charges · outpatientfrom % of charges | 4 | $4 | $4 | — | — | — | $4 – $4 |
| 8 | Mercy Health Services-Iowa Corp. Mason City, IA facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 9 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 10 | Mercy Medical Center - Dubuque Dubuque, IA facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 11 | Mercy Medical Center - Dyersville Dyersville, IA facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 12 | Mercy Medical Center - New Hampton New Hampton, IA facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 13 | Mercy Medical Center - Newton Newton, IA facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 14 | Mercy Medical Center-Clinton Inc Clinton, IA facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 15 | Mount Carmel East Reynoldsburg, OH facility · fee schedule · both | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 16 | Mount Carmel Grove City Grove City, OH facility · fee schedule · both | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 17 | Mount Carmel St Ann's Lewis Center, OH facility · fee schedule · both | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 18 | MultiCare Auburn Medical Center Auburn, WA percent of total billed charges · outpatientfrom % of charges | 4 | $4 | $4 | — | — | — | $4 – $4 |
| 19 | MultiCare Capital Medical Center Lacey, WA percent of total billed charges · outpatientfrom % of charges | 4 | $4 | $4 | — | — | — | $4 – $4 |
| 20 | MultiCare Covington Medical Center Covington, WA percent of total billed charges · outpatientfrom % of charges | 4 | $4 | $4 | — | — | — | $4 – $4 |
| 21 | Sartori Memorial Hospital Inc Cedar Falls, IA facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 22 | St. Joseph's Mercy Hospital, Centerville Centerville, IA facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 23 | Tacoma General Allenmore Hospital Bremerton, WA percent of total billed charges · outpatientfrom % of charges | 4 | $4 | $4 | — | — | — | $4 – $4 |
← Payers reporting CPT 90657 · Snapshot 20261113T090226Z-3ce6c0b8