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
$6
Average
$1.7k
Median
$10
High
$37.5k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
23 hospitals; the 90th percentile is 19.3× 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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23 hospital rates
iThe hospitals that file a Tricare 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 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $178 | $178 | — | — | — | $178 – $178 |
| 2 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $37.5k | $37.5k | — | — | — | $37.5k – $37.5k |
| 3 | Ascension Cedar Park Park, TX fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 4 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 5 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 6 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 7 | Ascension Seton Luling, TX fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 8 | Ascension Seton Burnet, TX fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 9 | Ascension Seton Smithville, TX fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 10 | Ascension Seton Bastrop, TX fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 11 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 12 | Austin Center for Outpatient Surgery LP, DBA Northwest Hills Surgical Hospital Austin, TX fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 13 | Beatrice Community Hospital Beatrice, NE fee schedule · outpatient | 1 | $6 | $6 | $2 | 27% | — | $4 – $7 |
| 14 | Carlsbad Medical Center LLC Carlsbad, NM facility · fee schedule · outpatient | 1 | $81 | $81 | — | — | — | $81 – $81 |
| 15 | Dukes Health System LLC Peru, IN facility · fee schedule · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 16 | Laredo Texas Hospital Company LP Laredo, TX facility · fee schedule · outpatient | 1 | $90 | $90 | — | — | — | $90 – $90 |
| 17 | Las Cruces Medical Center LLC Las Cruces, NM facility · fee schedule · outpatient | 1 | $171 | $171 | — | — | — | $171 – $171 |
| 18 | Natchez Hospital Company LLC Natchez, MS facility · fee schedule · outpatient | 1 | $216 | $216 | — | — | — | $216 – $216 |
| 19 | Northwest Hospital LLC Tucson, AZ facility · fee schedule · outpatient | 1 | $41 | $41 | — | — | — | $41 – $41 |
| 20 | Northwest Sahurita Hospital LLC Tucson, AZ facility · fee schedule · outpatient | 1 | $41 | $41 | — | — | — | $41 – $41 |
| 21 | Northwest Sahurita Hospital LLC Sahuarita, AZ facility · fee schedule · outpatient | 1 | $41 | $41 | — | — | — | $41 – $41 |
| 22 | Oro Valley Hospital LLC Tucson, AZ facility · fee schedule · outpatient | 1 | $41 | $41 | — | — | — | $41 – $41 |
| 23 | Presbyterian Medical Center of the University of Pennsylvania Health System D/B/A Penn Presbyterian Medical Center Philadelphia, PA facility · fee schedule · outpatient | 1 | $40 | $40 | — | — | — | $40 – $40 |
← Payers reporting CPT 90687 · Snapshot 20261113T090226Z-3ce6c0b8