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
Cciiv4 vacc abx free im
Low
$16
Average
$2.8k
Median
$94
High
$37.5k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
14 hospitals; the 90th percentile is 5.6× 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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14 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 | CLEVELAND AREA HOSPITAL CLEVELAND, OK percent of total billed charges · outpatientfrom % of charges | 1 | $20 | $20 | — | — | — | $20 – $20 |
| 3 | CentraState Medical Center Freehold Township, NJ fee schedule · outpatient | 2 | $91 | $91 | $5 | 5% | — | $86 – $96 |
| 4 | Chilton Medical Center Pompton Plains, NJ fee schedule · outpatient | 2 | $94 | $94 | $2 | 2% | — | $92 – $96 |
| 5 | Conway Regional Medical Center Conway, AR facility · fee schedule · outpatient | 1 | $43 | $43 | $4 | 10% | — | $38 – $49 |
| 6 | GRITMAN MEDICAL CENTER INC Moscow, ID facility · fee schedule · both | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 7 | Hackettstown Medical Center Hackettstown, NJ fee schedule · outpatient | 2 | $94 | $94 | $2 | 2% | — | $92 – $96 |
| 8 | Kaweah Health Medical Center Visalia, CA facility · fee schedule · outpatient | 1 | $150 | $150 | — | — | — | $150 – $150 |
| 9 | Kaweah Health Mental Health Hospital Visalia, CA facility · fee schedule · outpatient | 1 | $150 | $150 | — | — | — | $150 – $150 |
| 10 | Kaweah Health Rehabilitation Hospital Visalia, CA facility · fee schedule · outpatient | 1 | $150 | $150 | — | — | — | $150 – $150 |
| 11 | Morristown Medical Center Morristown, NJ fee schedule · outpatient | 2 | $94 | $94 | $2 | 2% | — | $92 – $96 |
| 12 | Newton Medical Center Newton, NJ fee schedule · outpatient | 2 | $94 | $94 | $2 | 2% | — | $92 – $96 |
| 13 | OUR LADY OF LOURDES MEMORIAL HOSPITAL INC. Doing Business As: LOURDES Binghamton, NY facility · other · outpatient | 1 | $65 | $65 | — | — | — | $65 – $65 |
| 14 | Overlook Medical Center Summit, NJ fee schedule · outpatient | 2 | $94 | $94 | $2 | 2% | — | $92 – $96 |
← Payers reporting CPT 90756 · Snapshot 20261112T181611Z-3fa9fb76