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
$13
Average
$75
Median
$25
High
$763
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20 hospital rates
iThe hospitals that file a Wellmark 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 | Gundersen Palmer Lutheran Hospital and Clinic Inc West Union, IA facility · case rate · outpatient | 2 | $61 | $61 | $3 | 5% | — | $59 – $64 |
| 2 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · both | 1 | $763 | $763 | — | — | — | $763 – $763 |
| 3 | Mercy Health Hackley Campus Muskogen, MI facility · fee schedule · both | 1 | $67 | $67 | — | — | — | $67 – $67 |
| 4 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · case rate · outpatient | 1 | $68 | $68 | — | — | — | $68 – $68 |
| 5 | MercyOne Genesis Silvis Medical Center Silvis, IL facility · case rate · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 6 | Meriter Hospital, Inc Madison, WI fee schedule · both | 1 | $24 | $24 | — | — | — | $24 – $24 |
| 7 | Monument Health Network Inc Spearfish, SD fee schedule · outpatient | 1 | $79 | $79 | — | — | — | $79 – $79 |
| 8 | Monument Health Network Inc Spearfish, SD other · outpatient | 1 | $27 | $27 | — | — | — | $27 – $27 |
| 9 | Monument Health Network Inc Deadwood, SD percent of total billed charges · outpatientfrom % of charges | 2 | $15 | $15 | $7 | 47% | — | $8 – $22 |
| 10 | Monument Health Network Inc Sturgis, SD percent of total billed charges · outpatientfrom % of charges | 2 | $13 | $13 | $7 | 52% | — | $6 – $21 |
| 11 | Monument Health Network Inc Custer, SD percent of total billed charges · outpatientfrom % of charges | 2 | $15 | $15 | $8 | 56% | — | $7 – $23 |
| 12 | Monument Health Rapid City Hospital Inc City, SD fee schedule · outpatient | 1 | $80 | $80 | — | — | — | $80 – $80 |
| 13 | Monument Health Rapid City Hospital Inc City, SD other · outpatient | 1 | $27 | $27 | — | — | — | $27 – $27 |
| 14 | Saint Alphonsus Medical Center - Baker City Baker City, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 15 | Saint Alphonsus Medical Center - Nampa Nampa, ID facility · fee schedule · both | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 16 | Saint Alphonsus Medical Center - Ontario Ontario, OR facility · fee schedule · both | 1 | $20 | $20 | — | — | — | $20 – $20 |
| 17 | Saint Alphonsus Regional Medical Center - Boise Boise, ID facility · fee schedule · both | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 18 | Trinity Medical Center Rock Island, IL fee schedule · both | 1 | $18 | $18 | — | — | — | $18 – $18 |
| 19 | Winner Regional Healthcare Center Winner, SD facility · percent of total billed charges · inpatientfrom % of charges | 1 | $14 | $14 | $14 | 94% | — | $1 – $28 |
| 20 | Winner Regional Healthcare Center Winner, SD facility · percent of total billed charges · outpatientfrom % of charges | 1 | $14 | $14 | $14 | 94% | — | $1 – $28 |
← Payers reporting CPT 90655 · Snapshot 20261113T090226Z-3ce6c0b8