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
Vacc aiiv4 no prsrv 0.5ml im
Low
$1
Average
$43
Median
$21
High
$153
Each hospital's average Amerihealth Caritas rate, under the methodology and billing class chosen below.
28 hospitals; the 90th percentile is 117.3× 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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28 hospital rates
iThe hospitals that file a Amerihealth Caritas 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 | Baptist Medical Center of Nassau, INC Yulee, FL facility · case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 2 | Baptist Medical Center of the Beaches, INC Beach, FL facility · case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 3 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 1 | $55 | $55 | — | — | — | $55 – $55 |
| 4 | Fairfield Medical Center 401 N Ewing St facility · fee schedule · outpatient | 1 | $81 | $81 | — | — | — | $81 – $81 |
| 5 | HIGHLANDS-CASHIERS HOSPITAL Highlands, NC percent of total billed charges · outpatientfrom % of charges | 1 | $95 | $95 | — | — | — | $95 – $95 |
| 6 | Lowell General Hospital Lowell, MA percent of total billed charges · bothfrom % of charges | 1 | $153 | $153 | — | — | — | $153 – $153 |
| 7 | MELROSEWAKEFIELD HEALTHCARE Medford, MA percent of total billed charges · bothfrom % of charges | 1 | $153 | $153 | — | — | — | $153 – $153 |
| 8 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 2 | $62 | $62 | $8 | 12% | — | $55 – $70 |
| 9 | Mount Carmel Dublin Dublin, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 10 | Mount Carmel East Reynoldsburg, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 11 | Mount Carmel Grove City Grove City, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 12 | Mount Carmel St Ann's Lewis Center, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 13 | Rex Hospital, Inc. Holly Springs, NC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 14 | Saint Alphonsus Medical Center - Baker City Baker City, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $31 | $31 | — | — | — | $31 – $31 |
| 15 | Saint Alphonsus Medical Center - Ontario Ontario, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 16 | Sarasota Memorial Hospital Sarasota, FL case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 17 | Sarasota Memorial Hospital - Venice North Venice, FL case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 18 | Southern Baptist Hospital of Florida, INC Fleming Island, FL facility · case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 19 | Southern Baptist Hospital of Florida, INC FL 32222; 461 Outlet Mall Blvd St. Augustine, FL facility · case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 20 | Southern Baptist Hospital of Florida, INC Jacksonville, FL facility · case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 21 | Southern Baptist Hospital of Florida, INC Jacksonville, FL facility · case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 22 | TRANSYLVANIA REGIONAL HOSPITAL Brevard, NC percent of total billed charges · outpatientfrom % of charges | 1 | $102 | $102 | — | — | — | $102 – $102 |
| 23 | The New London Hospital Association, Inc. London, NH professional · fee schedule · outpatient | 1 | $71 | $71 | — | — | — | $71 – $71 |
| 24 | Tufts Medical Center BOSTON, MA percent of total billed charges · bothfrom % of charges | 1 | $153 | $153 | — | — | — | $153 – $153 |
| 25 | Uniontown Hospital Uniontown, PA facility · fee schedule · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
← Payers reporting CPT 90694 · Snapshot 20261111T120946Z-9134e7f7