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
$156
Median
$19
High
$15.9k
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128 hospital rates
iThe hospitals that file a Molina 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 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 2 | Amisub of South Carolina, Inc. Fort Mill, SC fee schedule · both | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 3 | AnMed Piedmont Piedmont, SC professional · fee schedule · outpatient | 1 | $18 | $18 | — | — | — | $18 – $18 |
| 4 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE fee schedule · outpatient | 1 | $18 | $18 | $13 | 72% | — | $5 – $32 |
| 5 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE other · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 6 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE percent of total billed charges · outpatientfrom % of charges | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 7 | BRONXCARE HEALTH SYSTEM Bronx, NY other · outpatient | 2 | $14 | $20 | $13 | 63% | — | $14 – $46 |
| 8 | BRONXCARE HEALTH SYSTEM Bronx, NY other · outpatient | 2 | $14 | $20 | $13 | 63% | — | $14 – $46 |
| 9 | Baptist Medical Center of Nassau, INC Yulee, FL facility · case rate · outpatient | 1 | $22 | $22 | — | — | — | $22 – $22 |
| 10 | Baptist Medical Center of the Beaches, INC Beach, FL facility · case rate · outpatient | 1 | $22 | $22 | — | — | — | $22 – $22 |
| 11 | Bartow Regional Medical Center Bartow, FL facility · case rate · outpatient | 1 | $20 | $20 | — | — | — | $20 – $20 |
| 12 | BayCare Alliant Hospital Dunedin, FL facility · case rate · outpatient | 1 | $20 | $20 | — | — | — | $20 – $20 |
| 13 | Baycare Hospital Wesley Chapel Chapel, FL facility · case rate · outpatient | 1 | $20 | $20 | — | — | — | $20 – $20 |
| 14 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 15 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 16 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 17 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 18 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 19 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 20 | CLOVIS COMMUNITY MEDICAL CENTER Clovis, CA facility · fee schedule · inpatient | 1 | $31 | $31 | — | — | — | $31 – $31 |
| 21 | COMMUNITY MEMORIAL HOSPITAL Hill, VA case rate · outpatient | 1 | $40 | $40 | — | — | — | $40 – $40 |
| 22 | Carolinas Medical Center Charlotte, NC fee schedule · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 23 | Carolinas Medical Center Charlotte, NC fee schedule · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 24 | Carolinas Medical Center Charlotte, NC fee schedule · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 25 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA case rate · outpatient | 1 | $24 | $24 | — | — | — | $24 – $24 |
← Payers reporting CPT 90655 · Snapshot 20261113T090226Z-3ce6c0b8