Levothyroxine sodium injection, 100 mcg

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

LEVOTHYROXINE 100 MCG IV SOLR [113060]

Payers reporting HCPCS J0650

Payer pricing summary

Low

Average

$279

Median

$221

High

$878

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +23 other terms	446	$12	$42	$70	165%	—	$1 – $454
2	Cigna fee schedule · outpatient · +18 other terms	301	$14	$51	$75	148%	—	$1 – $442
3	Blue Cross Blue Shield fee schedule · outpatient · +26 other terms	213	$26	$48	$83	172%	—	$0 – $1.4k
4	Aetna fee schedule · outpatient · +22 other terms	201	$15	$92	$320	349%	—	$0 – $4.8k
5	Humana fee schedule · outpatient · +20 other terms	122	$7	$111	$104	94%	—	$5 – $621
6	Anthem fee schedule · outpatient · +17 other terms	74	$11	$13	$10	76%	—	$7 – $144
7	Kaiser fee schedule · both · +15 other terms	42	$9	$11	$14	122%	—	$8 – $145
8	Molina fee schedule · outpatient · +21 other terms	39	$13	$83	$251	300%	—	$1 – $2.0k
9	MultiPlan fee schedule · outpatient · +13 other terms	39	$256	$250	$99	40%	—	$1 – $558
10	Caresource fee schedule · outpatient · +13 other terms	38	$9	$13	$16	125%	—	$7 – $92
11	Highmark facility · fee schedule · outpatient · +11 other terms	29	$8	$12	$7	57%	—	$4 – $36
12	Medica fee schedule · outpatient · +12 other terms	28	$169	$197	$110	56%	—	$0 – $370
13	Medcost percent of total billed charges · outpatientfrom % of charges · +5 other terms	27	$328	$301	$257	86%	—	$61 – $1.5k
14	Excellus facility · fee schedule · both · +5 other terms	26	$80	$165	$139	84%	—	$60 – $666
15	Regence facility · fee schedule · both · +13 other terms	26	$91	$155	$138	89%	—	$60 – $666
16	Carefirst facility · fee schedule · both · +9 other terms	25	$80	$158	$142	90%	—	$60 – $666
17	Premera facility · fee schedule · both · +6 other terms	25	$80	$155	$139	90%	—	$60 – $666
18	Wellmark facility · fee schedule · both · +12 other terms	25	$80	$150	$134	90%	—	$60 – $666
19	Bcbs Tx fee schedule · outpatient · +3 other terms	23	$47	$46	$12	26%	—	$17 – $72
20	Bcbs La fee schedule · outpatient · +3 other terms	20	$10	$10	$0	2%	—	$8 – $10
21	Beechstreet percent of total billed charges · outpatientfrom % of charges · +3 other terms	20	$455	$499	$363	73%	—	$188 – $1.5k
22	Healthcare Highways percent of total billed charges · outpatientfrom % of charges · +2 other terms	20	$326	$703	$797	113%	—	$22 – $2.9k
23	Aetna Better Health other · outpatient · +11 other terms	19	$83	$114	$149	130%	—	$14 – $1.0k
24	Amerihealth Caritas other · outpatient · +11 other terms	19	$83	$114	$149	131%	—	$14 – $1.0k
25	Healthpartners fee schedule · outpatient · +9 other terms	18	$6	$6	$0	2%	—	$6 – $7

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