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
Sarscov & inf vir a&b ag ia
Fond Du Lac, WI
See all hospitals reporting CPT 87428 →Price type
Agnesian Healthcare Inc.’s median price of $81 is 11% above the median hospital's median price ($73), higher than 71% of the 1,734 hospitals reporting CPT 87428. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 4 payers, 5 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | ||||
|---|---|---|---|---|
| 1 | Blue Cross Blue Shield blue preferred / blue preferred plus hmo/pos fee schedule · outpatient | $45.96 | $45.96 | $45.96 – $45.96 |
| 2 | Molina medicare managed care plan fee schedule · outpatient | $52.72 | $52.72 | $52.72 – $52.72 |
| 3 | Blue Cross Blue Shield anthem medicare managed care plan fee schedule · outpatient | $70.29 | $70.29 | $70.29 – $70.29 |
| 4 | WellCare medicare managed care plan fee schedule · outpatient | $71.70 | $71.70 | $71.70 – $71.70 |
| 5 | UnitedHealthcare all commercial plans fee schedule · outpatient | $73.57 | $73.57 | $73.57 – $73.57 |
Last updated: Apr 1, 2026
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