Price Transparency
Pediatric Codes Pricing
Procedure codes and pricing, current and for the trailing 12 months.
| Procedure Code | Description | Price (8.1.26) | Price (10.5.26) | Reference Price | Reference Price Source | MCC Multiple |
|---|---|---|---|---|---|---|
| 90380 | Beyfortus | $624.82 | $624.82 | $595.06 | CDC | 1.05x |
| 90381 | Beyfortus | $624.82 | $624.82 | $595.06 | CDC | 1.05x |
| 90382 | Enflonsia | $583.80 | $583.80 | $556.00 | CDC | 1.05x |
| 90611 | Jynneos | $273.14 | $273.14 | $260.13 | CDC | 1.05x |
| 90619 | MenQuadfi | $185.96 | $185.96 | $177.11 | CDC | 1.05x |
| 90620 | Bexsero | $263.87 | $263.87 | $251.31 | CDC | 1.05x |
| 90621 | Trumenba | $237.21 | $237.21 | $225.91 | CDC | 1.05x |
| 90623 | Penbraya | $264.45 | $264.45 | $251.86 | CDC | 1.05x |
| 90624 | Penmenvy | $279.04 | $279.04 | $265.75 | CDC | 1.05x |
| 90633 | Havrix | $42.29 | $43.22 | $40.28 | CDC | 1.07x |
| 90633 | Vaqta | $42.29 | $43.22 | $41.17 | CDC | 1.05x |
| 90633 | Vaqta or Havrix Pediatric | $42.29 | $43.22 | $41.17 | CDC | 1.05x |
| 90636 | Twinrix | $148.68 | $148.68 | $141.60 | CDC | 1.05x |
| 90647 | PedvaxHIB | $33.05 | $35.95 | $34.24 | CDC | 1.05x |
| 90648 | ActHib | $14.61 | $14.61 | $13.91 | CDC | 1.05x |
| 90648 | Hiberix | $14.61 | $14.61 | $13.54 | CDC | 1.08x |
| 90651 | Gardasil 9 | $345.54 | $369.68 | $352.07 | CDC | 1.05x |
| 90678 | Abrysvo | $335.02 | $335.02 | $319.07 | CDC | 1.05x |
| 90680 | RotaTeq | $107.88 | $112.16 | $106.82 | CDC | 1.05x |
| 90681 | Rotarix | $163.59 | $163.59 | $155.80 | CDC | 1.05x |
| 90696 | Kinrix | $70.39 | $70.39 | $65.21 | CDC | 1.08x |
| 90696 | Quadracel | $70.39 | $70.39 | $67.04 | CDC | 1.05x |
| 90697 | Vaxelis | $175.73 | $175.73 | $167.36 | CDC | 1.05x |
| 90698 | Pentacel | $137.06 | $137.06 | $130.53 | CDC | 1.05x |
| 90700 | Daptacel | $33.09 | $33.09 | $31.52 | CDC | 1.05x |
| 90700 | Infanrix | $33.09 | $33.09 | $30.68 | CDC | 1.08x |
| 90707 | MMR-II | $102.89 | $105.91 | $100.86 | CDC | 1.05x |
| 90707 | Priorix | $102.89 | $105.91 | $97.99 | CDC | 1.08x |
| 90710 | ProQuad | $303.63 | $315.65 | $300.62 | CDC | 1.05x |
| 90713 | IPOL | $50.20 | $50.20 | $47.81 | CDC | 1.05x |
| 90716 | Varivax | $201.72 | $211.77 | $201.68 | CDC | 1.05x |
| 90723 | Pediarix | $116.77 | $116.77 | $111.21 | CDC | 1.05x |
| 90734 | Menveo | $185.54 | $185.54 | $176.71 | CDC | 1.05x |
| 91318 | Covid 0-5 | $68.83 | $68.83 | $65.55 | CMS | 1.05x |
| S3620 | Newborn metabolic screening | $94.81 | $94.81 | $94.81 | Texas HHSC | 1.00x |
Download the current pricing for this list as an Excel file.
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