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
Iiv adjuvant vaccine im
Low
$0
Average
$103
Median
$98
High
$466
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
60 hospitals; the 90th percentile is 1.3× 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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74 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 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY fee schedule · outpatient | 1 | $83 | $83 | — | — | — | $83 – $83 |
| 2 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient | 4 | $83 | $83 | — | — | — | $83 – $83 |
| 3 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $95 | $95 | — | — | — | $95 – $95 |
| 4 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $97 | $97 | — | — | — | $97 – $97 |
| 5 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 6 | Benefis Community Hospitals, Inc Choteau, MT other · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 7 | Bon Secours Community Hospital Jervis, NY facility · fee schedule · outpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 8 | CLEVELAND AREA HOSPITAL CLEVELAND, OK percent of total billed charges · bothfrom % of charges | 1 | $186 | $186 | — | — | — | $186 – $186 |
| 9 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · inpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 10 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · outpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 11 | Central Community Hospital Elkader, IA professional · fee schedule · inpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 12 | Central Community Hospital Elkader, IA professional · fee schedule · outpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 13 | Conway Regional Medical Center Conway, AR facility · fee schedule · outpatient | 1 | $309 | $309 | — | — | — | $309 – $309 |
| 14 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · inpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 15 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · outpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 16 | EAST BATON ROUGE MEDICAL CENTER, LLC Baton Rouge, LA fee schedule · outpatient | 1 | $83 | $83 | — | — | — | $83 – $83 |
| 17 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · fee schedule · outpatient | 1 | $87 | $87 | $11 | 13% | — | $76 – $98 |
| 18 | GRITMAN MEDICAL CENTER INC Moscow, ID facility · fee schedule · both | 1 | $112 | $112 | — | — | — | $112 – $112 |
| 19 | Glenwood Regional Medical Center - HSA West Monroe, LA facility · fee schedule · outpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 20 | Good Samaritan Hospital Suffern, NY facility · fee schedule · outpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 21 | HOSPITAL SERVICE DISTRICT NO. 1 OF THE PARISH OF ST. CHARLES, STATE OF LOUISIANA LULING, LA fee schedule · outpatient | 1 | $77 | $77 | $2 | 3% | — | $75 – $79 |
| 22 | HOSPITAL SERVICE DISTRICT OF THE PARISH OF ST. BERNARD, STATE OF LOUISIANA Chalmette, LA fee schedule · outpatient | 1 | $79 | $79 | — | — | — | $79 – $79 |
| 23 | HSA CGH LLC Coral Gables, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $95 | $95 | — | — | — | $95 – $95 |
| 24 | HSA PGH LLC Hialeah, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $95 | $95 | — | — | — | $95 – $95 |
| 25 | Hospital Service District #1, Parish of Terrebonne, State of Louisiana dba Terrebonne General Health System Houma, LA facility · fee schedule · outpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
← Payers reporting CPT 90653 · Snapshot 20261111T120946Z-9134e7f7