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 Pneumococcal Conjugate 20 Valent (Pcv20) Im
Low
$0
Average
$393
Median
$300
High
$1.9k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
202 hospitals; the 90th percentile is 3.8× 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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234 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 | ROBERT PACKER HOSPITAL Sayre, PA facility · other · outpatient | 2 | $1.2k | $1.1k | $778 | 72% | 95 | $85 – $1.8k |
| 2 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · outpatient | 1 | $313 | $313 | — | — | 48 | $313 – $313 |
| 3 | OUR LADY OF LOURDES MEMORIAL HOSPITAL INC. Doing Business As: LOURDES Binghamton, NY facility · other · outpatient | 1 | $85 | $85 | — | — | 25 | $85 – $85 |
| 4 | Mayo Clinic Health System Sparta, WI professional · fee schedule · outpatient | 1 | $313 | $313 | — | — | 15–24 | $313 – $313 |
| 5 | St. Charles Madras Madras, OR percent of total billed charges · bothfrom % of charges | 1 | $343 | $267 | $107 | 40% | 2–20 | $115 – $343 |
| 6 | Massachusetts General Hospital Boston, MA percent of total billed charges · bothfrom % of charges | 1 | $424 | $424 | — | — | 1–10 | $424 – $424 |
| 7 | Mishawaka Medical Center Mishawaka, IN professional · fee schedule · both | 1 | $313 | $313 | — | — | 1–10 | $313 – $313 |
| 8 | Mount Carmel St Ann's Lewis Center, OH professional · fee schedule · both | 1 | $313 | $313 | — | — | 1–10 | $313 – $313 |
| 9 | ROBERT PACKER HOSPITAL Doing Business As: ROBERT PACKER HOSPITAL, TOWANDA CAMPUS Towanda, PA facility · other · outpatient | 2 | $546 | $1.4k | $1.6k | 111% | 1–10 | $79 – $3.6k |
| 10 | Salem Hospital Salem, MA percent of total billed charges · bothfrom % of charges | 1 | $431 | $431 | — | — | 1–10 | $431 – $431 |
| 11 | Tufts Medical Center BOSTON, MA other · both | 1 | $1.7k | $1.7k | — | — | 1–10 | $1.7k – $1.7k |
| 12 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY fee schedule · outpatient | 1 | $298 | $298 | — | — | — | $298 – $298 |
| 13 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient | 4 | $313 | $313 | — | — | — | $313 – $313 |
| 14 | AnMed Health Anderson, SC professional · fee schedule · inpatient | 1 | $298 | $298 | — | — | — | $298 – $298 |
| 15 | AnMed Health Anderson, SC professional · fee schedule · outpatient | 1 | $298 | $298 | — | — | — | $298 – $298 |
| 16 | AnMed Health Cannon Pickens, SC professional · fee schedule · inpatient | 1 | $298 | $298 | — | — | — | $298 – $298 |
| 17 | AnMed Health Cannon Pickens, SC professional · fee schedule · outpatient | 1 | $298 | $298 | — | — | — | $298 – $298 |
| 18 | AnMed Piedmont Piedmont, SC professional · fee schedule · inpatient | 1 | $298 | $298 | — | — | — | $298 – $298 |
| 19 | AnMed Piedmont Piedmont, SC professional · fee schedule · outpatient | 1 | $298 | $298 | — | — | — | $298 – $298 |
| 20 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $304 | $304 | — | — | — | $304 – $304 |
| 21 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $310 | $310 | — | — | — | $310 – $310 |
| 22 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $313 | $313 | — | — | — | $313 – $313 |
| 23 | Aspen Valley Hospital District Aspen, CO facility · percent of total billed charges · bothfrom % of charges | 4 | $468 | $567 | $172 | 30% | — | $468 – $866 |
| 24 | Aspirus Divine Savior Hospital Portage, WI fee schedule · both | 1 | $298 | $298 | — | — | — | $298 – $298 |
| 25 | Aspirus Ironwood Hospital Ironwood, MI fee schedule · both | 1 | $298 | $298 | — | — | — | $298 – $298 |
← Payers reporting CPT 90677 · Snapshot 20261111T120946Z-9134e7f7