CPT 0173A

Pfizer COVID-19 bivalent booster dose for children 6 months to 4 years

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

Imm Admn Sarscov2 Bvl 3 Mcg/0.2 Ml 3rd Dose 6mo-4yrs

Payer pricing summary

Low

$13

Average

$92

Median

$56

High

$901

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Blue Cross Blue Shield fee schedule · outpatient · +16 other terms	80	$125	$128	$53	41%	—	$32 – $248
2	Anthem fee schedule · both · +11 other terms	28	$39	$33	$11	33%	—	$0 – $39
3	Molina facility · case rate · outpatient · +10 other terms	28	$26	$26	$10	41%	—	$11 – $57
4	UnitedHealthcare fee schedule · outpatient · +21 other terms	27	$45	$42	$18	44%	—	$11 – $76
5	Baylor Scott White Health Plan facility · percent of total billed charges · outpatientfrom % of charges	26	$43	$35	$9	27%	—	$10 – $46
6	Superior Healthplan facility · percent of total billed charges · outpatientfrom % of charges	25	$12	$13	$4	32%	—	$6 – $25
7	MultiPlan fee schedule · inpatient · +13 other terms	18	$66	$68	$5	7%	—	$58 – $75
8	Humana fee schedule · outpatient · +9 other terms	17	$52	$65	$31	48%	—	$13 – $103
9	Medica fee schedule · outpatient · +1 other terms	17	$58	$60	$13	21%	—	$26 – $76
10	Caresource facility · case rate · outpatient · +3 other terms	15	$16	$17	$4	23%	—	$11 – $27
11	Optum facility · case rate · outpatient · +7 other terms	13	$15	$18	$5	27%	—	$13 – $26
12	Tricare fee schedule · both · +4 other terms	13	$35	$36	$2	5%	—	$35 – $39
13	Wellmark fee schedule · both · +3 other terms	13	$40	$40	—	—	—	$40 – $40
14	Phcs fee schedule · inpatient · +6 other terms	10	$55	$62	$9	14%	—	$55 – $73
15	Aetna fee schedule · outpatient · +17 other terms	9	$47	$49	$12	25%	—	$22 – $72
16	Medcost percent of total billed charges · bothfrom % of charges · +2 other terms	9	$79	$79	$5	6%	—	$74 – $83
17	Aetna Better Health facility · case rate · outpatient · +5 other terms	7	$33	$32	$1	3%	—	$29 – $33
18	Amerihealth Caritas facility · case rate · outpatient · +3 other terms	7	$30	$30	$1	3%	—	$30 – $33
19	Cigna other · outpatient · +13 other terms	5	$52	$39	$18	45%	—	$18 – $62
20	Regence fee schedule · outpatient · +2 other terms	5	$69	$69	$11	16%	—	$53 – $82
21	Bcbs La other · outpatient · +1 other terms	4	$40	$36	$7	21%	—	$23 – $40
22	Highmark facility · fee schedule · outpatient · +4 other terms	4	$55	$58	$27	47%	—	$16 – $118
23	Bcbs Ma fee schedule · outpatient	3	$46	$46	—	—	—	$46 – $46
24	WellCare other · outpatient · +6 other terms	3	$40	$40	—	—	—	$40 – $40
25	Bcbs Ri fee schedule · outpatient	2	$41	$41	—	—	—	$41 – $41

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