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
Tacoma, WA
See all hospitals reporting CPT 87428 →Price type
Mary Bridge Children's Hospital’s median price of $70 is 4% below the median hospital's median price ($73), higher than 17% 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: 7 payers, 13 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 | Molina apple health fee schedule · outpatient | $5.09 | $5.09 | $5.09 – $5.09 |
| 2 | UnitedHealthcare apple health fee schedule · outpatient | $5.50 | $5.50 | $5.50 – $5.50 |
| 3 | Ambetter coordinated care exchange fee schedule · outpatient | $18.08 | $18.08 | $18.08 – $18.08 |
| 4 | Premera prime fee schedule · outpatient | $70.29 | $70.29 | $70.29 – $70.29 |
| 5 | Premera signature fee schedule · outpatient | $70.29 | $70.29 | $70.29 – $70.29 |
| 6 | Aetna medadvantage fee schedule · outpatient | $70.95 | $70.95 | $70.95 – $70.95 |
| 7 | Regence medadvantage fee schedule · outpatient | $70.95 | $70.95 | $70.95 – $70.95 |
| 8 | UnitedHealthcare medadvantage hmo fee schedule · outpatient | $71.64 | $71.64 | $71.64 – $71.64 |
| 9 | Molina medadvantage fee schedule · outpatient | $72.33 | $72.33 | $72.33 – $72.33 |
| 10 | WellCare medadvantage fee schedule · outpatient | $72.33 | $72.33 | $72.33 – $72.33 |
| 11 | Regence realvalue fee schedule · outpatient | $72.75 | $72.75 | $72.75 – $72.75 |
| 12 | Premera other commercial plans fee schedule · outpatient | $87.86 | $87.86 | $87.86 – $87.86 |
| 13 | Aetna all commercial plans fee schedule · outpatient | $217.20 | $217.20 | $217.20 – $217.20 |
Last updated: Aug 27, 2026
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