Influenza Vaccine, Quadrivalent Inactivated, 0.5 Ml Dosage
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Vaccines & Injections procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| North Dakota | $75.39 | $82.68 |
| Iowa | $75.37 | $84.87 |
| Nebraska | $75.03 | $83.82 |
| South Carolina | $75.03 | $87.88 |
| Pennsylvania | $75.02 | $86.83 |
| Maine | $74.99 | $85.46 |
| South Dakota | $74.98 | $78.15 |
| North Carolina | $74.92 | $101.07 |
| West Virginia | $74.90 | $94.22 |
| Vermont | $74.90 | $79.13 |
| Washington | $74.90 | $92.93 |
| Alabama | $74.90 | $83.35 |
| Ohio | $74.88 | $90.38 |
| Indiana | $74.80 | $88.36 |
| Utah | $74.77 | $87.10 |
| Kansas | $74.76 | $96.87 |
| Georgia | $74.75 | $91.41 |
| New Hampshire | $74.73 | $80.41 |
| Arkansas | $74.70 | $98.66 |
| Montana | $74.63 | $103.76 |
| Delaware | $74.62 | $81.39 |
| Virginia | $74.59 | $87.31 |
| Florida | $74.50 | $81.73 |
| U.S. Virgin Islands | $74.47 | $159.13 |
| Michigan | $74.47 | $80.86 |
| Kentucky | $74.45 | $96.45 |
| Missouri | $74.44 | $85.94 |
| Idaho | $74.43 | $86.92 |
| Arizona | $74.43 | $85.63 |
| Tennessee | $74.43 | $92.55 |
| Louisiana | $74.40 | $96.71 |
| Oklahoma | $74.37 | $95.16 |
| Maryland | $74.19 | $94.57 |
| Texas | $74.14 | $87.81 |
| Oregon | $74.14 | $92.60 |
| Hawaii | $74.05 | $76.84 |
| California | $73.96 | $89.38 |
| Wisconsin | $73.96 | $86.96 |
| Connecticut | $73.94 | $82.23 |
| Nevada | $73.88 | $84.22 |
| Massachusetts | $73.88 | $92.10 |
| Illinois | $73.74 | $86.12 |
| Wyoming | $73.71 | $87.14 |
| New York | $73.62 | $92.69 |
| New Jersey | $73.58 | $86.16 |
| District of Columbia | $73.52 | $97.56 |
| Mississippi | $73.15 | $94.05 |
| New Mexico | $73.14 | $84.61 |
| Puerto Rico | $71.54 | $73.21 |
| Colorado | $71.42 | $81.08 |
| Alaska | $70.18 | $81.41 |
| Guam | $68.66 | $90.92 |
| Rhode Island | $68.60 | $71.93 |
| Minnesota | $65.12 | $70.44 |
What the Data Says About Influenza Vaccine, Quadrivalent Inactivated, 0.5 Ml Dosage
Across 54 states with reporting providers, CPT code 90694 (Influenza Vaccine, Quadrivalent Inactivated, 0.5 Ml Dosage) shows a national average Medicare payment of $74.09 against an average billed charge of $88.01. That gap — a 1.2x markup, or 19% above the Medicare allowed amount — reflects chargemaster pricing, not what most insured patients actually pay. Medicare's negotiated rate is the statutory benchmark; commercial insurers typically settle between the two figures based on network contracts.
Vaccines & Injections procedures like this one saw 5.0M services billed to Medicare in 2023 by 80.9K distinct providers, serving 5.0M unique beneficiaries. State-level variation is significant: Minnesota reports the lowest average payment at $65.12, while North Dakota reports the highest at $75.39. Geographic Practice Cost Indices (GPCIs) explain much of that spread — local malpractice premiums, practice expense, and physician work adjustments all shift the allowed amount even when the procedure is identical.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Vaccines & Injections category (2.24x), the estimated commercial insurance price lands near $165.95, with self-pay cash discounts commonly bringing the figure closer to $79.77. Uninsured patients facing the full billed charge have the strongest leverage to negotiate — the Hospital Price Transparency Rule (effective January 2021) requires providers to publish standard charges, cash rates, and payer-specific negotiated prices. This data is for educational reference; confirm coverage and out-of-pocket exposure with your insurer before any procedure.
Frequently Asked Questions
How much does Influenza Vaccine, Quadrivalent Inactivated, 0.5 Ml Dosage cost?
The national average Medicare payment for Influenza Vaccine, Quadrivalent Inactivated, 0.5 Ml Dosage (CPT 90694) is $74.09, while providers typically bill $88.01. Prices vary significantly by state, ranging from $65.12 to $75.39.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Influenza Vaccine, Quadrivalent Inactivated, 0.5 Ml Dosage cost with insurance?
With commercial insurance, Influenza Vaccine, Quadrivalent Inactivated, 0.5 Ml Dosage costs an estimated $165.95 on average (range: $116.17 – $232.34). Without insurance, the estimated cash price is $79.77. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.
Which state has the lowest cost for Influenza Vaccine, Quadrivalent Inactivated, 0.5 Ml Dosage?
Minnesota has the lowest average Medicare payment for Influenza Vaccine, Quadrivalent Inactivated, 0.5 Ml Dosage at $65.12, while North Dakota has the highest at $75.39. This $10.26 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.
How many providers perform Influenza Vaccine, Quadrivalent Inactivated, 0.5 Ml Dosage?
Nationally, 80.9K providers billed Medicare for Influenza Vaccine, Quadrivalent Inactivated, 0.5 Ml Dosage in 2023, performing 5.0M total services for 5.0M beneficiaries across 54 states and territories.
What is the billed-to-Medicare markup for Influenza Vaccine, Quadrivalent Inactivated, 0.5 Ml Dosage?
Providers bill 1.2x what Medicare pays for Influenza Vaccine, Quadrivalent Inactivated, 0.5 Ml Dosage — a 19% markup. This gap between billed charges and actual payment is common across healthcare. Uninsured patients may face charges closer to the billed amount, while insured patients pay negotiated rates between the Medicare and billed figures.
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Related Data Sources
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology — how this data is sourced, computed, and verified.