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
$0
Average
$187
Median
$82
High
$11.6k
Each hospital's average UnitedHealthcare rate, under the methodology and billing class chosen below.
579 hospitals; the 90th percentile is 5.3× 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.
Filter by billing methodology
Filter by billing class
847 hospital rates
iThe hospitals that file a UnitedHealthcare 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 | Mary Hitchcock Memorial Hospital Lebanon, NH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $80 | $80 | — | — | 1,124 | $80 – $80 |
| 2 | Cheshire Medical Center Keene, NH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $80 | $80 | — | — | 469 | $80 – $80 |
| 3 | Virginia Mason Medical Center Seattle, WA facility · percent of total billed charges · outpatientfrom % of charges | 2 | $39 | $39 | $10 | 25% | 100 | $29 – $49 |
| 4 | Essentia Health Virginia 901 9th St N Virginia, MN facility · percent of total billed charges · outpatientfrom % of charges | 2 | $68 | $68 | $9 | 14% | 86 | $59 – $77 |
| 5 | Sarasota Memorial Hospital - Venice North Venice, FL percent of total billed charges · outpatientfrom % of charges | 1 | $169 | $169 | — | — | 68 | $169 – $169 |
| 6 | Grady Memorial Hospital Atlanta, GA facility · percent of total billed charges · outpatientfrom % of charges | 3 | $116 | $111 | $17 | 15% | 65 | $93 – $138 |
| 7 | Essentia Health St. Joseph's Medical Center Brainerd, MN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $93 | $93 | — | — | 34 | $93 – $93 |
| 8 | Essentia Health St. Mary's Children's Hospital Duluth, MN facility · percent of total billed charges · outpatientfrom % of charges | 2 | $83 | $83 | $18 | 22% | 23 | $64 – $101 |
| 9 | Essentia Health St. Mary's Medical Center Duluth, MN facility · percent of total billed charges · outpatientfrom % of charges | 2 | $83 | $83 | $18 | 22% | 23 | $64 – $101 |
| 10 | Essentia Health St. Mary's - Detroit Lakes 1027 Washington Ave. Detroit Lakes, MN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $59 | $59 | — | — | 20 | $59 – $59 |
| 11 | New Liberty Hospital Corporation Liberty, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $127 | $127 | — | — | 17 | $127 – $127 |
| 12 | Essentia Health Fargo 3000 32nd Ave S Fargo, ND facility · percent of total billed charges · outpatientfrom % of charges | 1 | $93 | $93 | — | — | 16 | $93 – $93 |
| 13 | BRIGHTON COMMUNITY HOSPITAL ASSOCIATION DBA INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL BRIGHTON, CO facility · percent of total billed charges · outpatientfrom % of charges | 14 | $111 | $112 | $3 | 3% | 14–140 | $111 – $117 |
| 14 | ST. MARY'S HOSPITAL & MEDICAL CENTER, INC. DBA INTERMOUNTAIN HEALTH ST. MARY'S REGIONAL HOSPITAL JUNCTION, CO facility · percent of total billed charges · outpatientfrom % of charges | 5 | $130 | $123 | $8 | 6% | 5–50 | $111 – $130 |
| 15 | GOOD SAMARITAN MEDICAL CENTER, LLC DBA LAFAYETTE, CO facility · percent of total billed charges · outpatientfrom % of charges | 4 | $130 | $130 | — | — | 4–40 | $130 – $130 |
| 16 | INTERMOUNTAIN FRONT RANGE INC. DBA INTERMOUNTAIN HEALTH LUTHERAN HOSPITAL WHEAT RIDGE, CO facility · percent of total billed charges · outpatientfrom % of charges | 4 | $117 | $117 | — | — | 4–40 | $117 – $117 |
| 17 | SAINT JOSEPH HOSPITAL, INC. DBA INTERMOUNTAIN NHEALTH SAINT JOSEPH HOSPITAL DENVER, CO facility · percent of total billed charges · outpatientfrom % of charges | 4 | $117 | $117 | — | — | 4–40 | $117 – $117 |
| 18 | SCL HEALTH - MONTANA, DBA INTERMOUNTAIN HEALTH ST. VINCENT HEALTHCARE Billings, MT facility · percent of total billed charges · outpatientfrom % of charges | 4 | $130 | $130 | — | — | 4–40 | $130 – $130 |
| 19 | St. James Healthcare INTERMOUNTAIN HEALTH ST JAMES HOSPITAL Butte, MT facility · percent of total billed charges · outpatientfrom % of charges | 3 | $130 | $130 | — | — | 3–30 | $130 – $130 |
| 20 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $129 | $129 | — | — | 1–10 | $129 – $129 |
| 21 | Essentia Health Duluth Duluth, MN facility · percent of total billed charges · outpatientfrom % of charges | 2 | $57 | $57 | $7 | 13% | 1–10 | $50 – $64 |
| 22 | IHC Health Services Inc., DBA Intermountain Health Intermountain Medical Center Murray, UT facility · percent of total billed charges · outpatientfrom % of charges | 1 | $77 | $77 | — | — | 1–10 | $77 – $77 |
| 23 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · percent of total billed charges · outpatientfrom % of charges | 1 | $109 | $109 | — | — | 1–10 | $109 – $109 |
| 24 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · percent of total billed charges · outpatientfrom % of charges | 1 | $109 | $109 | — | — | 1–10 | $109 – $109 |
| 25 | ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA percent of total billed charges · outpatientfrom % of charges | 3 | $117 | $92 | $41 | 44% | — | $34 – $123 |
← Payers reporting CPT 90694 · Snapshot 20261112T124536Z-e251e855