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  5. /Case rate
CPT 90685

IIV4 VACC NO PRSV 0.25 ML IM

Reported by 14 hospitals in the network under the case rate methodology.

Filter by billing methodology

All methodologiesAggregated across all available billing methodologies for this code.Case rateCMS definition: a flat rate for a package of items and services triggered by a diagnosis, treatment, or condition for a designated length of time.Fee scheduleCMS definition: the payer-specific negotiated charge is based on a fee schedule — for example, a Medicare, Medicaid, commercial payer, or workers’ compensation fee schedule.Per diemCMS definition: the per day charge for providing hospital items and services.Percent of billed chargesCMS definition: the payer-specific negotiated charge is based on a percentage of the total billed charges for an item or service, which may vary depending on certain pre-determined criteria being met.OtherCMS definition: used when the standard charge methodology can’t be described by case rate, fee schedule, per diem, or percent of total billed charges.

Reflects a negotiated flat case rate paid per episode of care, rather than itemized charges.

National pricing summary

Low

$0

Average

$335

Median

$270

High

$887

Hospitals reporting this code

#HospitalLocationApproximate number of payer billing records behind this hospital’s price. CMS privacy rules cap small counts as a range (e.g. “1–10”) rather than an exact number — more samples means a more reliable price.
1Florida Coast Medical and Surgical Center, Inc.Port St. Lucie, FL$0$0$0—$0$78
2Natchez Hospital Company LLCNatchez, MS$22$22$0—$22$614
3Wesley Health System LLCHattiesburg, MS$22$22$0—$22$354
4Vicksburg Healthcare LLCVicksburg, MS$22$22——$22$445
5Las Cruces Medical Center LLCLas Cruces, NM$26$27$1—$26$152
6Mount Carmel New Albany Surgical HospitalNew Albany, OH$632$632——$15$632
7Mount Carmel Grove CityGrove City, OH$632$632——$11$632
8Diley Ridge Medical CenterCanal Winchester, OH$632$632——$6$632
9Mount Carmel St Ann'sWesterville, OH$632$632——$11$632
10Mount Carmel EastColumbus, OH$632$632——$11$632
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