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
Iiv4 vaccine splt 0.25 ml im
Low
$3
Average
$21
Median
$12
High
$231
Each hospital's average Amerihealth Caritas rate, under the methodology and billing class chosen below.
40 hospitals; the 90th percentile is 2.5× 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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40 hospital rates
iThe hospitals that file a Amerihealth Caritas 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 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY other · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 2 | Baptist Medical Center of Nassau, INC Yulee, FL facility · case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 3 | Baptist Medical Center of the Beaches, INC Beach, FL facility · case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 4 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 5 | Fairfield Medical Center 401 N Ewing St facility · fee schedule · outpatient | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 6 | Geisinger St Luke's Hospital - Orwigsburg Campus Orwigsburg, PA facility · fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 7 | HIGHLANDS-CASHIERS HOSPITAL Highlands, NC percent of total billed charges · outpatientfrom % of charges | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 8 | LAFAYETTE GENERAL MEDICAL CENTER INC Lafayette, LA other · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 9 | Lowell General Hospital Lowell, MA percent of total billed charges · bothfrom % of charges | 1 | $44 | $44 | — | — | — | $44 – $44 |
| 10 | MELROSEWAKEFIELD HEALTHCARE Medford, MA percent of total billed charges · bothfrom % of charges | 1 | $44 | $44 | — | — | — | $44 – $44 |
| 11 | OCHSNER CLINIC FOUNDATION LA 70121; 4430 Veterans Memorial Blvd.Metairie, LA other · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 12 | Ochsner American Legion Hospital, LLC Jennings, LA other · outpatient | 1 | $265 | $231 | $117 | 51% | — | $9 – $352 |
| 13 | Rex Hospital, Inc. Holly Springs, NC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 14 | SOUTHERN REGIONAL MEDICAL CORPORATION Houma, LA other · outpatient | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 15 | Saint Alphonsus Medical Center - Ontario Ontario, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 16 | Sarasota Memorial Hospital Sarasota, FL case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 17 | Sarasota Memorial Hospital - Venice North Venice, FL case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 18 | Southern Baptist Hospital of Florida, INC Fleming Island, FL facility · case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 19 | Southern Baptist Hospital of Florida, INC FL 32222; 461 Outlet Mall Blvd St. Augustine, FL facility · case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 20 | Southern Baptist Hospital of Florida, INC Jacksonville, FL facility · case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 21 | Southern Baptist Hospital of Florida, INC Jacksonville, FL facility · case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 22 | St Luke's Hospital - Allentown Campus Allentown, PA facility · fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 23 | St Luke's Hospital - Anderson Campus Easton, PA facility · fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 24 | St Luke's Hospital - Bethlehem Campus Bethlehem, PA facility · fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 25 | St Luke's Hospital - Carbon Campus Lehighton, PA facility · fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
← Payers reporting CPT 90687 · Snapshot 20261113T090226Z-3ce6c0b8