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
Menb-4c Recombnt Prot & Outer Memb Vesic Vacc Im
Low
$0
Average
$266
Median
$239
High
$1.2k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
145 hospitals; the 90th percentile is 4.1× 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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166 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 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · outpatient | 1 | $251 | $251 | — | — | 18 | $251 – $251 |
| 2 | Massachusetts General Hospital Boston, MA percent of total billed charges · bothfrom % of charges | 1 | $289 | $289 | — | — | 1–10 | $289 – $289 |
| 3 | Mayo Clinic Health System Sparta, WI professional · fee schedule · outpatient | 1 | $251 | $251 | — | — | 1–10 | $251 – $251 |
| 4 | Mishawaka Medical Center Mishawaka, IN professional · fee schedule · both | 1 | $251 | $251 | — | — | 1–10 | $251 – $251 |
| 5 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient | 4 | $251 | $251 | — | — | — | $251 – $251 |
| 6 | AnMed Health Anderson, SC professional · fee schedule · inpatient | 1 | $219 | $219 | — | — | — | $219 – $219 |
| 7 | AnMed Health Anderson, SC professional · fee schedule · outpatient | 1 | $219 | $219 | — | — | — | $219 – $219 |
| 8 | AnMed Health Cannon Pickens, SC professional · fee schedule · inpatient | 1 | $219 | $219 | — | — | — | $219 – $219 |
| 9 | AnMed Health Cannon Pickens, SC professional · fee schedule · outpatient | 1 | $219 | $219 | — | — | — | $219 – $219 |
| 10 | AnMed Piedmont Piedmont, SC professional · fee schedule · inpatient | 1 | $219 | $219 | — | — | — | $219 – $219 |
| 11 | AnMed Piedmont Piedmont, SC professional · fee schedule · outpatient | 1 | $219 | $219 | — | — | — | $219 – $219 |
| 12 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $244 | $244 | — | — | — | $244 – $244 |
| 13 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $249 | $249 | — | — | — | $249 – $249 |
| 14 | Aspirus Rhinelander Hospital Rhinelander, WI fee schedule · both | 1 | $237 | $237 | — | — | — | $237 – $237 |
| 15 | Aspirus St. Luke’s Hospital Duluth, MN fee schedule · both | 1 | $244 | $244 | — | — | — | $244 – $244 |
| 16 | Aspirus Wausau Hospital Wausau, WI fee schedule · both | 1 | $183 | $183 | — | — | — | $183 – $183 |
| 17 | Aspirus Wisconsin Rapids Hospital Wisconsin Rapids, WI fee schedule · both | 1 | $183 | $183 | — | — | — | $183 – $183 |
| 18 | Bay Park Community Hospital Oregon, OH facility · fee schedule · outpatient | 1 | $239 | $239 | — | — | — | $239 – $239 |
| 19 | Bay Park Community Hospital Oregon, OH professional · fee schedule · outpatient | 1 | $239 | $239 | — | — | — | $239 – $239 |
| 20 | Benefis Hospitals Inc Helena, MT fee schedule · outpatient | 1 | $219 | $219 | — | — | — | $219 – $219 |
| 21 | Bluffton Health System LLC Bluffton, IN facility · fee schedule · outpatient | 1 | $0 | $48 | $96 | 200% | — | $0 – $239 |
| 22 | Bon Secours Community Hospital Jervis, NY facility · fee schedule · outpatient | 1 | $251 | $251 | — | — | — | $251 – $251 |
| 23 | Brandon HMA LLC Brandon, MS facility · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 24 | COLUMBIA MEMORIAL HOSPITAL Hudson, NY professional · fee schedule · outpatient | 4 | $251 | $251 | — | — | — | $251 – $251 |
| 25 | CORNING HOSPITAL Corning, NY facility · other · outpatient | 2 | $827 | $827 | $499 | 60% | — | $328 – $1.3k |
← Payers reporting CPT 90620 · Snapshot 20261111T120946Z-9134e7f7