Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

#455 of 11K

90686

Influenza virus vaccine, quadrivalent, preservative-free, IM

Influenza virus vaccine, quadrivalent, preservative-free, IM is the #455 most-billed Medicaid procedure code, with $215.0M in payments across 39.4M claims from 2018–2024. The national median cost per claim is $7.18. Costs vary widely — the 90th percentile is $18.77 per claim, 2.6× the median.

Total Paid

$215.0M

0.02% of all spending

Total Claims

39.4M

Providers

35K

Avg Cost/Claim

$5

National Cost Distribution

How much do providers bill per claim for 90686? Based on 28K providers billing this code nationally.

Median

$7.18

Average

$8.99

Std Dev

$13.23

Max

$654.00

Percentile Distribution (Cost per Claim)

p10
$0.22
p25
$1.61
Median
$7.18
p75
$13.69
p90
$18.77
p95
$21.16
p99
$30.13

50% of providers bill between $1.61 and $13.69 per claim for this code.

90% bill between $0.22 and $18.77.

Top 1% bill above $30.13.

About This Procedure

HCPCS code 90686 (Influenza virus vaccine, quadrivalent, preservative-free, IM) was billed by 35K providers across 39.4M claims, totaling $215.0M in Medicaid payments from 2018–2024. This code was used for 36.6M unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$7.18

Providers Billing

28K

National Spending

$215.0M

Avg/Median Ratio

1.25×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for 90686

#ProviderTotal Paid
1Nyu Langone Hospitals

Brooklyn, NY · General Acute Care Hospital

$4.4M
2Mid Atlantic Pemanente Medical Group

Rockville, MD · Health Maintenance Organization

$3.4M
3Arkansas Department Of Health Immunizations

Little Rock, AR · Public Health or Welfare

$2.8M
4Montefiore Medical Center

Bronx, NY · General Acute Care Hospital

$1.8M
5Nationwide Children's Hospital

Columbus, OH · General Acute Care Hospital

$1.4M
6Children's Hospital Medical Center Of Akron

Akron, OH · General Acute Care Hospital Children

$1.4M
71366425274$1.1M
8The Metrohealth System

Cleveland, OH · General Acute Care Hospital

$1.1M
91548500713$994K
10The Nemours Foundation

Wilmington, DE · Clinic/Center, Developmental Disabilities

$957K
11The New York And Presbyterian Hospital

New York, NY · General Acute Care Hospital

$944K
12Arkansas Childrens Hospital

Little Rock, AR · Clinic/Center, Critical Access Hospital

$908K
131144203498$887K
141750443503$859K
15Cambridge Public Health Commission

Cambridge, MA · General Acute Care Hospital

$843K
16Utah Navajo Health System, Incorporated

Montezuma Creek, UT · Family Medicine

$766K
171376949503$700K
181003985755$677K
19Mary Imogene Bassett Hospital

Cooperstown, NY · General Acute Care Hospital, Rural

$636K
20Virginia Commonwealth University Health System Authority

Richmond, VA · General Acute Care Hospital

$621K

Showing top 20 of 35K providers billing this code