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
$9
Average
$42
Median
$9
High
$763
Each hospital's average Excellus rate, under the methodology and billing class chosen below.
25 hospitals; the 90th percentile is 2.3× 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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26 hospital rates
iThe hospitals that file a Excellus 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 | $9 | $9 | — | — | — | $9 – $9 |
| 2 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA facility · fee schedule · both | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 3 | Central Community Hospital Elkader, IA facility · fee schedule · both | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 4 | Clifton Springs Hospital And Clinic Clifton Springs, NY facility · fee schedule · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 5 | Covenant Medical Center Inc Waterloo, IA facility · fee schedule · both | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 6 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · both | 1 | $763 | $763 | — | — | — | $763 – $763 |
| 7 | Mercy Health Hackley Campus Muskogen, MI facility · fee schedule · both | 1 | $30 | $30 | — | — | — | $30 – $30 |
| 8 | Mercy Health Services-Iowa Corp. Mason City, IA facility · fee schedule · both | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 9 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · fee schedule · both | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 10 | Mercy Medical Center - Dubuque Dubuque, IA facility · fee schedule · both | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 11 | Mercy Medical Center - Dyersville Dyersville, IA facility · fee schedule · both | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 12 | Mercy Medical Center - New Hampton New Hampton, IA facility · fee schedule · both | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 13 | Mercy Medical Center - Newton Newton, IA facility · fee schedule · both | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 14 | Mercy Medical Center-Clinton Inc Clinton, IA facility · fee schedule · both | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 15 | Rochester General Hospital Rochester, NY facility · fee schedule · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 16 | Saint Alphonsus Medical Center - Nampa Nampa, ID facility · percent of total billed charges · bothfrom % of charges | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 17 | Saint Alphonsus Medical Center - Ontario Ontario, OR facility · fee schedule · both | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 18 | Saint Alphonsus Medical Center - Ontario Ontario, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 19 | Saint Alphonsus Regional Medical Center - Boise Boise, ID facility · percent of total billed charges · bothfrom % of charges | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 20 | Sartori Memorial Hospital Inc Cedar Falls, IA facility · fee schedule · both | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 21 | St Joseph Mercy Chelsea Chelsea, MI facility · fee schedule · both | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 22 | St Joseph Mercy Oakland Pontiac, MI facility · fee schedule · both | 1 | $19 | $19 | — | — | — | $19 – $19 |
| 23 | St. Joseph's Mercy Hospital, Centerville Centerville, IA facility · fee schedule · both | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 24 | Strong Memorial Hospital Rochester, NY fee schedule · both | 4 | $10 | $10 | $0 | 2% | — | $10 – $10 |
| 25 | The Unity Hospital of Rochester Rochester, NY facility · fee schedule · outpatient | 2 | $10 | $10 | — | — | — | $10 – $10 |
← Payers reporting CPT 90687 · Snapshot 20261113T090226Z-3ce6c0b8