CPT 90655
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
Iiv3 vacc no prsv 0.25 ml im
Low
$0
Average
$138
Median
$21
High
$17.6k
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428 hospital rates
iThe hospitals that file a Aetna 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 other · outpatient | 1 | $61 | $61 | $25 | 41% | — | $36 – $86 |
| 2 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient | 1 | $18 | $18 | — | — | — | $18 – $18 |
| 3 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · fee schedule · outpatient | 2 | $33 | $33 | $4 | 12% | — | $29 – $37 |
| 4 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient | 6 | $16 | $16 | $0 | 1% | — | $16 – $17 |
| 5 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 6 | Adena Fayette Medical Center Washington Court House, OH facility · fee schedule · outpatient | 1 | $41 | $41 | — | — | — | $41 – $41 |
| 7 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 1 | $41 | $41 | — | — | — | $41 – $41 |
| 8 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 2 | $22 | $22 | $0 | 1% | — | $21 – $22 |
| 9 | Alta Newport Hospital, LLC Tustin, CA facility · case rate · outpatient | 2 | $41 | $41 | — | — | — | $41 – $41 |
| 10 | Alta Newport Hospital, LLC Tustin, CA facility · percent of total billed charges · inpatientfrom % of charges | 3 | $46 | $42 | $5 | 12% | — | $35 – $46 |
| 11 | Alta Newport Hospital, LLC Tustin, CA facility · percent of total billed charges · outpatientfrom % of charges | 3 | $46 | $42 | $5 | 12% | — | $35 – $46 |
| 12 | AnMed Piedmont Piedmont, SC professional · fee schedule · inpatient | 2 | $16 | $16 | — | — | — | $16 – $16 |
| 13 | AnMed Piedmont Piedmont, SC professional · fee schedule · outpatient | 2 | $16 | $16 | — | — | — | $16 – $16 |
| 14 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 15 | Ascension St. Vincent Heart Center Carmel, IN other · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 16 | Ascension Via Christi Hospital Manhattan, Inc. Manhattan, KS fee schedule · outpatient | 1 | $30 | $30 | $30 | 100% | — | $0 – $61 |
| 17 | Ascension Via Christi Rehabilitation Hospital, Inc. Wichita, KS fee schedule · outpatient | 1 | $40 | $40 | — | — | — | $40 – $40 |
| 18 | Aspirus Iron River Hospital Iron River, MI fee schedule · both | 1 | $44 | $44 | — | — | — | $44 – $44 |
| 19 | Aurora BayCare Medical Center Green Bay, WI fee schedule · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 20 | Aurora Lakeland Medical Center Elkhorn, WI fee schedule · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 21 | Aurora Medical Center Bay Area Marinette, WI fee schedule · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 22 | Aurora Medical Center Burlington Burlington, WI fee schedule · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 23 | Aurora Medical Center Fond du Lac Fond Du Lac, WI fee schedule · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 24 | Aurora Medical Center Grafton Grafton, WI fee schedule · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 25 | Aurora Medical Center Kenosha Kenosha, WI fee schedule · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
← Payers reporting CPT 90655 · Snapshot 20261113T090226Z-3ce6c0b8