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
$6
Average
$29
Median
$21
High
$112
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22 hospital rates
iThe hospitals that file a Medicaid 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 | ACADIAN MEDICAL CENTER EUNICE, LA percent of total billed charges · bothfrom % of charges | 6 | $112 | $112 | $77 | 68% | — | $36 – $189 |
| 2 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient | 1 | $28 | $28 | $2 | 5% | — | $26 – $29 |
| 3 | ADVENTIST HEALTH MENDOCINO COAST Bragg, CA fee schedule · outpatient | 1 | $26 | $26 | $0 | 0% | — | $26 – $26 |
| 4 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · case rate · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 5 | Clarion Hospital Clarion, PA facility · case rate · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 6 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient | 1 | $19 | $19 | — | — | — | $19 – $19 |
| 7 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 8 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · case rate · outpatient | 1 | $19 | $19 | — | — | — | $19 – $19 |
| 9 | LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA fee schedule · outpatient | 1 | $26 | $34 | $13 | 39% | — | $23 – $52 |
| 10 | MELROSEWAKEFIELD HEALTHCARE Medford, MA percent of total billed charges · bothfrom % of charges | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 11 | REEDLEY COMMUNITY HOSPITAL Reedley, CA fee schedule · outpatient | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 12 | SONORA COMMUNITY HOSPITAL Sonora, CA fee schedule · outpatient | 1 | $32 | $32 | $6 | 17% | — | $26 – $37 |
| 13 | Saint Alphonsus Medical Center - Baker City Baker City, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 14 | Saint Alphonsus Medical Center - Ontario Ontario, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 15 | Ste. Genevieve County Memorial Hospital Ste. Genevieve, MO percent of total billed charges · outpatientfrom % of charges | 1 | $31 | $31 | — | — | — | $31 – $31 |
| 16 | Stephens County Hospital Toccoa, GA percent of total billed charges · outpatientfrom % of charges | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 17 | Tufts Medical Center BOSTON, MA percent of total billed charges · bothfrom % of charges | 1 | $24 | $24 | — | — | — | $24 – $24 |
| 18 | UKIAH ADVENTIST HOSPITAL Ukiah, CA fee schedule · outpatient | 1 | $26 | $55 | $41 | 75% | — | $26 – $114 |
| 19 | Victoria of Texas LP Victoria, TX facility · fee schedule · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 20 | Victoria of Texas LP Victoria, TX facility · fee schedule · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 21 | WHITE MEMORIAL MEDICAL CENTER MONTEBELLO, CA fee schedule · outpatient | 1 | $93 | $93 | — | — | — | $93 – $93 |
| 22 | WILLITS HOSPITAL INC Willits, CA fee schedule · outpatient | 1 | $26 | $26 | $0 | 0% | — | $26 – $26 |
← Payers reporting CPT 90655 · Snapshot 20261113T090226Z-3ce6c0b8