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
PR Vaccine Influenza Trivalent (Riv3) Rdna Antibiotic/Preservative Free Im
Low
$40
Average
$95
Median
$96
High
$232
Each hospital's average Clover rate, under the methodology and billing class chosen below.
29 hospitals; the 90th percentile is 2.7× 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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35 hospital rates
iThe hospitals that file a Clover 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 | Central Georgia Rehabilitation LLC Macon, GA fee schedule · outpatient | 1 | $100 | $100 | — | — | — | $100 – $100 |
| 2 | Conway Hospital, Inc. Conway, SC professional · fee schedule · outpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 3 | Floyd Healthcare Management Inc Rome, GA case rate · outpatient | 1 | $101 | $101 | — | — | — | $101 – $101 |
| 4 | Grady Memorial Hospital Atlanta, GA professional · fee schedule · outpatient | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 5 | Inspira Health Center Bridgeton Bridgeton, NJ fee schedule · outpatient | 1 | $83 | $83 | — | — | — | $83 – $83 |
| 6 | Inspira Health Center Woodbury Woodbury, NJ fee schedule · outpatient | 1 | $83 | $83 | — | — | — | $83 – $83 |
| 7 | Inspira Medical Center Elmer Elmer, NJ fee schedule · outpatient | 1 | $83 | $83 | — | — | — | $83 – $83 |
| 8 | Inspira Medical Center Mannington Salem, NJ fee schedule · outpatient | 1 | $83 | $83 | — | — | — | $83 – $83 |
| 9 | Inspira Medical Center Mullica Hill Hill, NJ fee schedule · outpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 10 | Inspira Medical Center Vineland Vineland, NJ fee schedule · outpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 11 | Mercy Health Hackley Campus Muskogen, MI professional · fee schedule · inpatient | 1 | $96 | $96 | — | — | — | $96 – $96 |
| 12 | Mercy Health Hackley Campus Muskogen, MI professional · fee schedule · outpatient | 1 | $96 | $96 | — | — | — | $96 – $96 |
| 13 | Mount Carmel St Ann's Lewis Center, OH professional · percent of total billed charges · bothfrom % of charges | 1 | $167 | $167 | — | — | — | $167 – $167 |
| 14 | Navicent Health Baldwin Inc Milledgeville, GA fee schedule · outpatient | 1 | $100 | $100 | — | — | — | $100 – $100 |
| 15 | Northside Hospital, Inc. Lawrenceville, GA fee schedule · outpatient | 1 | $55 | $55 | $9 | 16% | — | $46 – $63 |
| 16 | Northside Hospital, Inc. Atlanta, GA fee schedule · outpatient | 1 | $58 | $58 | $9 | 16% | — | $49 – $67 |
| 17 | Northside Hospital, Inc. Cumming, GA fee schedule · outpatient | 1 | $55 | $55 | $9 | 16% | — | $46 – $63 |
| 18 | Northside Hospital, Inc. Duluth, GA fee schedule · outpatient | 1 | $55 | $55 | $9 | 16% | — | $46 – $63 |
| 19 | Northside Hospital, Inc. Canton, GA fee schedule · outpatient | 1 | $40 | $40 | $6 | 16% | — | $34 – $46 |
| 20 | Penn Medicine Princeton Medical Center Princeton, NJ facility · other · outpatient | 1 | $232 | $232 | — | — | — | $232 – $232 |
| 21 | Pennsylvania Hospital of the University of Pennsylvania Health System Philadelphia, PA facility · other · outpatient | 1 | $100 | $100 | — | — | — | $100 – $100 |
| 22 | Presbyterian Medical Center of the University of Pennsylvania Health System D/B/A Penn Presbyterian Medical Center Philadelphia, PA facility · other · outpatient | 1 | $44 | $44 | $18 | 41% | — | $26 – $63 |
| 23 | Samaritan Hospital Troy, NY professional · percent of total billed charges · inpatientfrom % of charges | 1 | $161 | $161 | — | — | — | $161 – $161 |
| 24 | Samaritan Hospital Troy, NY professional · percent of total billed charges · outpatientfrom % of charges | 1 | $137 | $137 | — | — | — | $137 – $137 |
| 25 | St Joseph Mercy Ann Arbor Ypsilanti, MI professional · fee schedule · inpatient | 1 | $96 | $96 | — | — | — | $96 – $96 |
← Payers reporting CPT 90673 · Snapshot 20261111T120946Z-9134e7f7