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 NOVAVAX COVID-19 VACCINE, 5 MCG/0.5ML IM
Low
$0
Average
$149
Median
$153
High
$192
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
13 hospitals; the 90th percentile is 1.4× 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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15 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 | $186 | $186 | — | — | — | $186 – $186 |
| 2 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $190 | $190 | — | — | — | $190 – $190 |
| 3 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $137 | $137 | — | — | — | $137 – $137 |
| 4 | Massena Hospital Inc Massena, NY facility · fee schedule · outpatient | 1 | $192 | $192 | — | — | — | $192 – $192 |
| 5 | McLeod Health Dillon, SC fee schedule · both | 1 | $153 | $153 | — | — | — | $153 – $153 |
| 6 | McLeod Health Cheraw, SC fee schedule · both | 1 | $153 | $153 | — | — | — | $153 – $153 |
| 7 | McLeod Health Manning, SC fee schedule · both | 1 | $153 | $153 | — | — | — | $153 – $153 |
| 8 | McLeod Health Florence, SC fee schedule · both | 1 | $153 | $153 | — | — | — | $153 – $153 |
| 9 | McLeod Health Beach, SC fee schedule · both | 1 | $153 | $153 | — | — | — | $153 – $153 |
| 10 | McLeod Health Loris, SC fee schedule · both | 1 | $153 | $153 | — | — | — | $153 – $153 |
| 11 | McLeod Health River, SC fee schedule · both | 1 | $153 | $153 | — | — | — | $153 – $153 |
| 12 | NORTHERN MAINE MEDICAL CENTER FORT KENT, ME other · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 13 | NORTHERN MAINE MEDICAL CENTER FORT KENT, ME other · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 14 | Presbyterian Medical Center of the University of Pennsylvania Health System D/B/A Penn Presbyterian Medical Center Philadelphia, PA facility · fee schedule · outpatient | 1 | $192 | $192 | — | — | — | $192 – $192 |
| 15 | SOUTHERN REGIONAL MEDICAL CORPORATION Houma, LA fee schedule · outpatient | 1 | $149 | $149 | $4 | 3% | — | $145 – $153 |
← Payers reporting CPT 91304 · Snapshot 20261113T090226Z-3ce6c0b8