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
$7
Average
$879
Median
$29
High
$25.6k
Each hospital's average Medical Mutual rate, under the methodology and billing class chosen below.
30 hospitals; the 90th percentile is 3.4× 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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34 hospital rates
iThe hospitals that file a Medical Mutual 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 · percent of total billed charges · bothfrom % of charges | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 2 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 3 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $24 | $24 | — | — | — | $24 – $24 |
| 4 | Covenant Medical Center Inc Waterloo, IA facility · fee schedule · both | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 5 | Dupont Hospital LLC Wayne, IN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $28 | $28 | — | — | — | $28 – $28 |
| 6 | Dupont Hospital LLC Wayne, IN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $28 | $28 | — | — | — | $28 – $28 |
| 7 | Fairfield Medical Center 401 N Ewing St facility · fee schedule · outpatient | 1 | $17.6k | $17.6k | — | — | — | $17.6k – $17.6k |
| 8 | Fairfield Medical Center 401 N Ewing St facility · percent of total billed charges · outpatientfrom % of charges | 1 | $33.5k | $33.5k | — | — | — | $33.5k – $33.5k |
| 9 | Mercy Health Hackley Campus Muskogen, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 10 | Mercy Health Services-Iowa Corp. Mason City, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $18 | $18 | — | — | — | $18 – $18 |
| 11 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $29 | $29 | — | — | — | $29 – $29 |
| 12 | Mercy Medical Center - Dubuque Dubuque, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $28 | $28 | — | — | — | $28 – $28 |
| 13 | Mercy Medical Center - Dyersville Dyersville, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 14 | Mercy Medical Center - New Hampton New Hampton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $30 | $30 | — | — | — | $30 – $30 |
| 15 | Mercy Medical Center - Newton Newton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $30 | $30 | — | — | — | $30 – $30 |
| 16 | Mercy Medical Center-Clinton Inc Clinton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $30 | $30 | — | — | — | $30 – $30 |
| 17 | Sartori Memorial Hospital Inc Cedar Falls, IA facility · fee schedule · both | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 18 | St Joseph Mercy Chelsea Chelsea, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 19 | St Joseph Mercy Oakland Pontiac, MI facility · fee schedule · both | 1 | $29 | $29 | — | — | — | $29 – $29 |
| 20 | St. Joseph Health System, LLC Wayne, IN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $52 | $52 | — | — | — | $52 – $52 |
| 21 | St. Joseph Health System, LLC Wayne, IN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $52 | $52 | — | — | — | $52 – $52 |
| 22 | St. Joseph's Mercy Hospital, Centerville Centerville, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $30 | $30 | — | — | — | $30 – $30 |
| 23 | University Hospitals Health System Chardon, OH facility · fee schedule · outpatient | 3 | $33 | $33 | $3 | 8% | — | $30 – $37 |
| 24 | University Hospitals Health System Ravenna, OH facility · fee schedule · outpatient | 3 | $30 | $30 | $2 | 8% | — | $27 – $33 |
| 25 | University Hospitals Health System Chardon, OH facility · case rate · outpatient | 1 | $31 | $31 | — | — | — | $31 – $31 |
← Payers reporting CPT 90687 · Snapshot 20261113T090226Z-3ce6c0b8