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
$2
Average
$2.3k
Median
$22
High
$37.5k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
17 hospitals; the 90th percentile is 32.3× 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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18 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 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $37.5k | $37.5k | — | — | — | $37.5k – $37.5k |
| 2 | Aspirus Keweenaw Hospital Laurium, MI fee schedule · both | 1 | $22 | $22 | — | — | — | $22 – $22 |
| 3 | Aspirus Langlade Hospital Antigo, WI fee schedule · both | 1 | $22 | $22 | — | — | — | $22 – $22 |
| 4 | Aspirus Rhinelander Hospital Rhinelander, WI fee schedule · both | 1 | $22 | $22 | — | — | — | $22 – $22 |
| 5 | Aspirus Wausau Hospital Wausau, WI fee schedule · both | 1 | $22 | $22 | — | — | — | $22 – $22 |
| 6 | Aspirus Wisconsin Rapids Hospital Wisconsin Rapids, WI fee schedule · both | 1 | $22 | $22 | — | — | — | $22 – $22 |
| 7 | Beatrice Community Hospital Beatrice, NE fee schedule · outpatient | 1 | $5 | $5 | $1 | 20% | — | $4 – $6 |
| 8 | Beaufort Memorial Hospital Beaufort, SC facility · percent of total billed charges · inpatientfrom % of charges | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 9 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · fee schedule · outpatient | 1 | $46 | $46 | $21 | 45% | — | $25 – $67 |
| 10 | Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $115 | $115 | — | — | — | $115 – $115 |
| 11 | Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $108 | $108 | — | — | — | $108 – $108 |
| 12 | Gadsden Regional Medical Center LLC Gadsden, AL facility · fee schedule · outpatient | 1 | $202 | $202 | — | — | — | $202 – $202 |
| 13 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 14 | Penn Medicine Princeton Medical Center Princeton, NJ facility · fee schedule · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 15 | Presbyterian Medical Center of the University of Pennsylvania Health System D/B/A Penn Presbyterian Medical Center Philadelphia, PA facility · fee schedule · outpatient | 1 | $32 | $32 | — | — | — | $32 – $32 |
| 16 | St. Charles Madras Madras, OR percent of total billed charges · bothfrom % of charges | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 17 | Victoria of Texas LP Victoria, TX facility · fee schedule · outpatient | 2 | $276 | $276 | $31 | 11% | — | $246 – $307 |
| 18 | Victoria of Texas LP Victoria, TX facility · fee schedule · outpatient | 2 | $276 | $276 | $31 | 11% | — | $246 – $307 |
← Payers reporting CPT 90655 · Snapshot 20261113T090226Z-3ce6c0b8