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
Sarscov2 Vacc 10mcg/0.3ml Tris-Sucrose Im Use
Low
$0
Average
$99
Median
$88
High
$430
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
53 hospitals; the 90th percentile is 1.1× 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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62 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 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient | 4 | $88 | $88 | — | — | — | $88 – $88 |
| 2 | AnMed Health Anderson, SC professional · fee schedule · inpatient | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 3 | AnMed Health Anderson, SC professional · fee schedule · outpatient | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 4 | AnMed Health Cannon Pickens, SC professional · fee schedule · inpatient | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 5 | AnMed Health Cannon Pickens, SC professional · fee schedule · outpatient | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 6 | AnMed Piedmont Piedmont, SC professional · fee schedule · inpatient | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 7 | AnMed Piedmont Piedmont, SC professional · fee schedule · outpatient | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 8 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $92 | $92 | — | — | — | $92 – $92 |
| 9 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $94 | $94 | — | — | — | $94 – $94 |
| 10 | Bluffton Health System LLC Bluffton, IN facility · fee schedule · outpatient | 1 | $90 | $90 | — | — | — | $90 – $90 |
| 11 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · inpatient | 1 | $95 | $95 | — | — | — | $95 – $95 |
| 12 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · outpatient | 1 | $95 | $95 | — | — | — | $95 – $95 |
| 13 | Dupont Hospital LLC Wayne, IN facility · fee schedule · outpatient | 1 | $90 | $90 | — | — | — | $90 – $90 |
| 14 | Durant HMA LLC Durant, OK facility · fee schedule · outpatient | 1 | $95 | $95 | — | — | — | $95 – $95 |
| 15 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · fee schedule · outpatient | 1 | $95 | $95 | — | — | — | $95 – $95 |
| 16 | GLENS FALLS HOSPITAL INC Falls, NY professional · fee schedule · outpatient | 4 | $88 | $88 | — | — | — | $88 – $88 |
| 17 | Glenwood Regional Medical Center - HSA West Monroe, LA facility · fee schedule · outpatient | 1 | $95 | $95 | — | — | — | $95 – $95 |
| 18 | HMA Santa Rosa Medical Center LLC Milton, FL facility · fee schedule · outpatient | 1 | $90 | $90 | — | — | — | $90 – $90 |
| 19 | HSA CGH LLC Coral Gables, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $92 | $92 | — | — | — | $92 – $92 |
| 20 | HSA PGH LLC Hialeah, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $92 | $92 | — | — | — | $92 – $92 |
| 21 | IOM Health System LP Fort Wayne, IN facility · fee schedule · outpatient | 1 | $90 | $90 | — | — | — | $90 – $90 |
| 22 | Kaweah Health Rehabilitation Hospital Visalia, CA facility · fee schedule · outpatient | 1 | $430 | $430 | — | — | — | $430 – $430 |
| 23 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $81 | $81 | — | — | — | $81 – $81 |
| 24 | Lutheran Musculoskeletal Center LLC Fort Wayne, IN facility · fee schedule · outpatient | 1 | $90 | $90 | — | — | — | $90 – $90 |
| 25 | MCLAREN CARO REGION CARO, MI fee schedule | 1 | $167 | $167 | — | — | — | $167 – $167 |
← Payers reporting CPT 91319 · Snapshot 20261112T181611Z-3fa9fb76