90472

Administration of vaccine, each additional vaccine

Medicare pricing data for 12,030 providers across 51 states

🤖AI Overview

Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Administration of vaccine, each additional vaccine (HCPCS code 90472) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $13.74, but hospitals typically charge $32.23 — a 2.3x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$2.75

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $13.74, your out-of-pocket cost would be approximately $2.75. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$13.74
Average Hospital Charge
$32.23
Markup Ratio
2.3x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$32.23
Medicare Allowed$13.74
Medicare Payment$9.14

Hospitals charge 2.3x more than what Medicare allows for this procedure. Medicare actually pays $9.14 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$16$30107295+18.2%
Alaska$16$3661167+17.7%
New York$16$41422845+15.1%
New Jersey$15$376711,430+11.1%
California$15$41188332+9.2%
Connecticut$15$347491+9.2%
Maryland$15$296681,965+7.7%
Massachusetts$15$39381865+7.1%
Illinois$14$33299573+5.4%
New Hampshire$14$4172231+4.4%
Virginia$14$316911,564+4.1%
Hawaii$14$41517+4.0%
Oregon$14$405077+3.8%
Michigan$14$2368254+2.0%
Maine$14$363361+2.0%
Colorado$14$296851,585+2.0%
Texas$14$371,0792,900-0.7%
Washington$14$3185167-0.9%
Georgia$14$415211,195-0.9%
North Dakota$14$51720-1.3%
Delaware$14$2764161-1.5%
Minnesota$14$41168263-1.7%
Florida$13$347101,532-1.8%
Pennsylvania$13$291,2112,232-2.3%
Rhode Island$13$324892-2.3%
Montana$13$261120-3.1%
Arizona$13$2580174-3.1%
Nevada$13$312246-3.4%
Wisconsin$13$41185264-3.8%
Missouri$13$2684141-4.5%
South Carolina$13$30199355-4.7%
North Carolina$13$317811,921-4.9%
Indiana$13$3097141-5.2%
South Dakota$13$441435-5.5%
Nebraska$13$283848-6.5%
Louisiana$13$27201560-6.7%
Iowa$13$323859-6.9%
Kansas$13$314559-7.1%
Wyoming$13$1621107-7.4%
West Virginia$13$2955100-7.6%
Idaho$13$291943-7.6%
New Mexico$13$30129300-8.0%
Tennessee$13$28350804-8.2%
Alabama$13$27186517-8.2%
Arkansas$12$24202765-10.5%
Utah$12$243250-11.3%
Oklahoma$12$25263765-11.6%
Vermont$12$261723-12.6%
Kentucky$12$27205306-13.9%
Ohio$12$28247324-15.4%
Mississippi$12$28128270-15.6%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber