CPT 0104A

COVID-19 booster vaccine, 5 mcg dose, adult

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Fee Schedule

Payer pricing summary

Low

$19

Average

$62

Median

$63

High

$124

Payer rate distribution

Filter by billing methodology

All methodologies Case rate 14 Fee schedule 17 Per diem 6 Percent of billed charges 16 Other 0

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +2 other terms	22	$44	$41	$19	48%	—	$11 – $76
2	Blue Cross Blue Shield fee schedule · outpatient · +3 other terms	19	$145	$106	$49	46%	—	$32 – $165
3	MultiPlan fee schedule · inpatient · +1 other terms	18	$66	$68	$5	7%	—	$58 – $75
4	Medica fee schedule · outpatient · +1 other terms	17	$58	$60	$13	21%	—	$26 – $76
5	Humana fee schedule · outpatient	11	$45	$44	$11	26%	—	$26 – $57
6	Highmark fee schedule · outpatient · +3 other terms	10	$44	$44	—	—	—	$44 – $44
7	Phcs fee schedule · inpatient · +1 other terms	10	$55	$62	$9	14%	—	$55 – $73
8	Aetna fee schedule · outpatient · +3 other terms	5	$54	$51	$6	11%	—	$40 – $54
9	Anthem facility · fee schedule · outpatient · +1 other terms	5	$93	$86	$35	41%	—	$19 – $119
10	Regence fee schedule · outpatient · +1 other terms	5	$69	$69	$11	16%	—	$53 – $82

Page 1 of 2 · 17 payers

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