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
$0
Average
$22
Median
$16
High
$215
Each hospital's average Cigna rate, under the methodology and billing class chosen below.
498 hospitals; the 90th percentile is 3.2× 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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566 hospital rates
iThe hospitals that file a Cigna 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 | $63 | $63 | — | — | — | $63 – $63 |
| 2 | ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA percent of total billed charges · outpatientfrom % of charges | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 3 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 4 | ADVENTIST HEALTH MENDOCINO COAST Bragg, CA percent of total billed charges · outpatientfrom % of charges | 1 | $20 | $20 | $6 | 33% | — | $13 – $26 |
| 5 | ALBANY GENERAL HOSPITAL Albany, OR professional · fee schedule · outpatient | 2 | $10 | $10 | — | — | — | $10 – $10 |
| 6 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · inpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 7 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 8 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 9 | Advocate Childrens Hospital Oak Lawn Oak Lawn, IL facility · fee schedule · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 10 | Advocate Childrens Hospital Park Ridge Park Ridge, IL facility · fee schedule · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 11 | Advocate Christ Medical Center Oak Lawn, IL facility · fee schedule · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 12 | Advocate Condell Medical Center Libertyville, IL fee schedule · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 13 | Advocate Good Samaritan Hospital Downers Grove, IL fee schedule · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 14 | Advocate Good Shepherd Hospital Barrington, IL fee schedule · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 15 | Advocate Illinois Masonic Medical Center Chicago, IL fee schedule · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 16 | Advocate Lutheran General Hospital Park Ridge, IL fee schedule · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 17 | Advocate Sherman Hospital Elgin, IL fee schedule · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 18 | Advocate South Suburban Hospital Hazel Crest, IL fee schedule · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 19 | Advocate Trinity Hospital Chicago, IL fee schedule · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 20 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 21 | Alexian Brothers Behavioral Health Hospital Estates, IL fee schedule · outpatient | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 22 | Alexian Brothers Medical Center Village, IL fee schedule · outpatient | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 23 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 24 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 25 | Ascension SE Wisconsin Hospital, Inc. Milwaukee, WI other · outpatient | 1 | $32 | $32 | — | — | — | $32 – $32 |
← Payers reporting CPT 90687 · Snapshot 20261113T090226Z-3ce6c0b8