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
Cciiv4 vac no prsv 0.5 ml im
Low
$16
Average
$104
Median
$35
High
$763
Each hospital's average Carefirst rate, under the methodology and billing class chosen below.
11 hospitals; the 90th percentile is 4.6× 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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13 hospital rates
iThe hospitals that file a Carefirst 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 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · both | 1 | $763 | $763 | — | — | — | $763 – $763 |
| 2 | Potomac Hospital Corporation of Prince William Lake Ridge, VA facility · fee schedule · outpatient | 2 | $50 | $50 | $3 | 6% | — | $47 – $53 |
| 3 | Saint Alphonsus Medical Center - Baker City Baker City, OR facility · percent of total billed charges · bothfrom % of charges | 2 | $20 | $16 | $5 | 30% | — | $10 – $20 |
| 4 | Saint Alphonsus Medical Center - Nampa Nampa, ID facility · percent of total billed charges · bothfrom % of charges | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 5 | Saint Alphonsus Medical Center - Ontario Ontario, OR facility · fee schedule · both | 1 | $54 | $54 | — | — | — | $54 – $54 |
| 6 | Saint Alphonsus Medical Center - Ontario Ontario, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 7 | Saint Alphonsus Regional Medical Center - Boise Boise, ID facility · percent of total billed charges · bothfrom % of charges | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 8 | Samaritan Hospital Troy, NY facility · fee schedule · both | 2 | $32 | $32 | — | — | — | $32 – $32 |
| 9 | St Joseph Mercy Chelsea Chelsea, MI facility · fee schedule · both | 1 | $75 | $75 | — | — | — | $75 – $75 |
| 10 | St Joseph Mercy Oakland Pontiac, MI facility · fee schedule · both | 1 | $61 | $61 | — | — | — | $61 – $61 |
| 11 | St Peters Hospital Albany, NY facility · fee schedule · both | 2 | $32 | $32 | — | — | — | $32 – $32 |
| 12 | UPMC Hanover Hanover, PA facility · percent of total billed charges · inpatientfrom % of charges | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 13 | UPMC Hanover Hanover, PA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $49 | $49 | — | — | — | $49 – $49 |
← Payers reporting CPT 90674 · Snapshot 20261112T181611Z-3fa9fb76