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
$8
Average
$29
Median
$24
High
$161
Each hospital's average First Health rate, under the methodology and billing class chosen below.
69 hospitals; the 90th percentile is 5.0× 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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87 hospital rates
iThe hospitals that file a First Health 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 | ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA percent of total billed charges · outpatientfrom % of charges | 1 | $44 | $44 | — | — | — | $44 – $44 |
| 2 | Adena Fayette Medical Center Washington Court House, OH facility · fee schedule · outpatient | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 3 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 4 | Affinity Hospital LLC Birmingham, AL facility · other · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 5 | Affinity Hospital LLC Birmingham, AL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $174 | $174 | — | — | — | $174 – $174 |
| 6 | BURLESON ST. JOSEPH HEALTH CENTER OF CALDWELL, TEXAS Caldwell, TX fee schedule · inpatient | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 7 | BURLESON ST. JOSEPH HEALTH CENTER OF CALDWELL, TEXAS Caldwell, TX fee schedule · outpatient | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 8 | Bexar County Hospital District San Antonio, TX percent of total billed charges · inpatientfrom % of charges | 1 | $39 | $39 | $3 | 7% | — | $37 – $42 |
| 9 | Bexar County Hospital District San Antonio, TX percent of total billed charges · outpatientfrom % of charges | 1 | $47 | $47 | $5 | 10% | — | $42 – $51 |
| 10 | Bluffton Health System LLC Bluffton, IN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $33 | $33 | $12 | 35% | — | $22 – $45 |
| 11 | Bluffton Health System LLC Bluffton, IN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $33 | $33 | $12 | 35% | — | $22 – $45 |
| 12 | Broaddus Hospital Association Inc Philippi, WV professional · fee schedule · both | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 13 | Carlsbad Medical Center LLC Carlsbad, NM facility · percent of total billed charges · outpatientfrom % of charges | 1 | $76 | $76 | — | — | — | $76 – $76 |
| 14 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 15 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 16 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $24 | $24 | — | — | — | $24 – $24 |
| 17 | Covenant Medical Center Inc Waterloo, IA facility · fee schedule · both | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 18 | Davis Medical Center Elkins, WV professional · fee schedule · both | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 19 | Deaconess Health System Gibson General Hospital Princeton, IN professional · fee schedule · both | 1 | $8 | $8 | $8 | 100% | — | $0 – $16 |
| 20 | Deaconess Health System Henderson Hospital Henderson, KY professional · fee schedule · both | 1 | $8 | $8 | $8 | 100% | — | $0 – $16 |
| 21 | Deaconess Health System Union County Hospital Morganfield, KY professional · fee schedule · both | 1 | $8 | $8 | $8 | 100% | — | $0 – $16 |
| 22 | Deaconess Hospital, Inc Newburgh, IN professional · fee schedule · both | 1 | $8 | $8 | $8 | 100% | — | $0 – $16 |
| 23 | Deaconess Hospital, Inc Newburgh, IN professional · fee schedule · both | 1 | $8 | $8 | $8 | 100% | — | $0 – $16 |
| 24 | Deaconess Regional Healthcare Services Illinois Inc Marion, IL professional · percent of total billed charges · bothfrom % of charges | 1 | $16 | $16 | $13 | 82% | — | $3 – $30 |
| 25 | Dukes Health System LLC Peru, IN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $42 | $42 | — | — | — | $42 – $42 |
← Payers reporting CPT 90687 · Snapshot 20261113T090226Z-3ce6c0b8