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
RESP VIRUS 12-25 TARGETS
Luling, TX
See all hospitals reporting CPT 87633 →Price type
Ascension Seton’s median price of $350 is 26% below the median hospital's median price ($472), higher than 5% of the 2,323 hospitals reporting CPT 87633. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 7 payers, 49 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 3594_blue cross chip/star kids (chi,dcn) inpatient 20240901 fee schedule · both | $29 | $29 | — | — | — | $29 – $29 |
| 2 | Blue Cross Blue Shield 3596_blue cross chip/star kids (ebd) inpatient 20240901 fee schedule · both | $29 | $29 | — | — | — | $29 – $29 |
| 3 | Blue Cross Blue Shield 3693_chirp blue cross star (chi,dcn) inpatient 20240901 fee schedule · both | $29 | $29 | — | — | — | $29 – $29 |
| 4 | Blue Cross Blue Shield 3695_chirp blue cross star (ebd) inpatient 20240901 fee schedule · both | $29 | $29 | — | — | — | $29 – $29 |
| 5 | UnitedHealthcare 3737_chirp uhc star (chi,dcn) inpatient 20240901 fee schedule · both | $29 | $29 | — | — | — | $29 – $29 |
| 6 | UnitedHealthcare 3739_chirp uhc star (ebd) inpatient 20240901 fee schedule · both | $29 | $29 | — | — | — | $29 – $29 |
| 7 | UnitedHealthcare 3748_chirp uhc star plus (chi,dcn) inpatient 20240901 fee schedule · both | $29 | $29 | — | — | — | $29 – $29 |
| 8 | UnitedHealthcare 3750_chirp uhc star plus (ebd) inpatient 20240901 fee schedule · both | $29 | $29 | — | — | — | $29 – $29 |
| 9 | UnitedHealthcare 4322_uhc star kids (chi,dcn) inpatient 20240901 fee schedule · both | $29 | $29 | — | — | — | $29 – $29 |
| 10 | UnitedHealthcare 4324_uhc star kids (ebd) inpatient 20240901 fee schedule · both | $29 | $29 | — | — | — | $29 – $29 |
| 11 | Superior Healthplan 4188_superior star foster outpatient 20241201 fee schedule · outpatient | $379 | $326 | $75 | 23% | — | $220 – $379 |
| 12 | Superior Healthplan 4189_superior star foster (chi,dcn) outpatient 20241201 fee schedule · outpatient | $379 | $326 | $75 | 23% | — | $220 – $379 |
| 13 | Superior Healthplan 4241_chirp superior star (chi,dcn) outpatient 20241201 fee schedule · outpatient | $379 | $326 | $75 | 23% | — | $220 – $379 |
| 14 | Superior Healthplan 4243_chirp superior star (ebd) outpatient 20241201 fee schedule · outpatient | $379 | $326 | $75 | 23% | — | $220 – $379 |
| 15 | Superior Healthplan 4389_chirp superior star plus (chi,dcn) outpatient 20241201 fee schedule · outpatient | $379 | $326 | $75 | 23% | — | $220 – $379 |
| 16 | Superior Healthplan 4393_chirp superior star plus (ebd) outpatient 20241201 fee schedule · outpatient | $379 | $326 | $75 | 23% | — | $220 – $379 |
| 17 | Superior Healthplan 4888_superior star kids outpatient 20241201 fee schedule · outpatient | $379 | $326 | $75 | 23% | — | $220 – $379 |
| 18 | Superior Healthplan 4889_superior star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $379 | $326 | $75 | 23% | — | $220 – $379 |
| 19 | Ambetter 3880_superior ambetter (chi,dcn) outpatient 20240901 fee schedule · outpatient | $350 | $350 | — | — | — | $350 – $350 |
| 20 | Blue Cross Blue Shield 4168_blue cross chip (chi,dcn) outpatient 20241201 fee schedule · outpatient | $350 | $350 | — | — | — | $350 – $350 |
| 21 | Blue Cross Blue Shield 4168_blue cross chip/star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $350 | $350 | — | — | — | $350 – $350 |
| 22 | Blue Cross Blue Shield 4170_blue cross chip (ebd) outpatient 20241201 fee schedule · outpatient | $350 | $350 | — | — | — | $350 – $350 |
| 23 | Blue Cross Blue Shield 4170_blue cross chip/star kids (ebd) outpatient 20241201 fee schedule · outpatient | $350 | $350 | — | — | — | $350 – $350 |
| 24 | Blue Cross Blue Shield 5003_blue cross star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $350 | $350 | — | — | — | $350 – $350 |
| 25 | Blue Cross Blue Shield 5007_blue cross star kids (ebd) outpatient 20241201 fee schedule · outpatient | $350 | $350 | — | — | — | $350 – $350 |
Last updated: Jan 1, 2026
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