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]

Blue Cross Blue Shield pricing summary

Low

Average

$168

Median

$60

High

$4.7k

Blue Cross Blue Shield rate distribution

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922 hospital rates

#		Plans
1	Mayo Clinic Arizona Phoenix, AZ facility · percent of total billed charges · bothfrom % of charges	5	$234	$249	$31	13%	1–10	$234 – $312
2	Mayo Clinic Florida Jacksonville, FL facility · percent of total billed charges · bothfrom % of charges	6	$538	$606	$422	70%	1–10	$173 – $1.4k
3	ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA case rate · outpatient	2	$361	$361	—	—	—	$361 – $361
4	ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA fee schedule · outpatient	1	$23	$23	—	—	—	$23 – $23
5	ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA percent of total billed charges · outpatientfrom % of charges	5	$116	$231	$145	63%	—	$112 – $408
6	ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA case rate · outpatient	2	$494	$494	$26	5%	—	$468 – $520
7	ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA percent of total billed charges · outpatientfrom % of charges	3	$381	$334	$119	36%	—	$171 – $451
8	ADVENTIST HEALTH MENDOCINO COAST Bragg, CA fee schedule · outpatient	1	$12	$12	—	—	—	$12 – $12
9	ADVENTIST HEALTH MENDOCINO COAST Bragg, CA percent of total billed charges · outpatientfrom % of charges	3	$188	$209	$63	30%	—	$145 – $294
10	ADVENTIST HEALTH TULARE Tulare, CA case rate · outpatient	1	$376	$376	—	—	—	$376 – $376
11	ADVENTIST HEALTH TULARE Tulare, CA fee schedule · outpatient	1	$32	$32	—	—	—	$32 – $32
12	ADVENTIST HEALTH TULARE Tulare, CA percent of total billed charges · outpatientfrom % of charges	2	$280	$280	$45	16%	—	$235 – $325
13	ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · case rate · inpatient	4	$160	$206	$76	37%	—	$133 – $299
14	ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · case rate · outpatient	4	$160	$206	$76	37%	—	$133 – $299
15	ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · inpatientfrom % of charges	7	$54	$214	$230	107%	—	$49 – $550
16	ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · outpatientfrom % of charges	7	$114	$446	$471	106%	—	$111 – $1.1k
17	ALEGENT CREIGHTON HEALTH Plainview, NE fee schedule · inpatient	2	$300	$308	$23	8%	—	$282 – $348
18	ALEGENT CREIGHTON HEALTH Plainview, NE fee schedule · outpatient	3	$289	$273	$54	20%	—	$190 – $348
19	ALEGENT HEALTH - MERCY HOSPITAL, CORNING IOWA Corning, IA fee schedule · outpatient	1	$138	$143	$10	7%	—	$134 – $157
20	ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · inpatient	2	$300	$308	$23	8%	—	$282 – $348
21	ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · outpatient	2	$300	$308	$23	8%	—	$282 – $348
22	ALEGENT HEALTH MEMORIAL HOSPITAL, SCHUYLER Schuyler, NE fee schedule · inpatient	2	$300	$308	$23	8%	—	$282 – $348
23	ALEGENT HEALTH MEMORIAL HOSPITAL, SCHUYLER Schuyler, NE fee schedule · outpatient	3	$289	$262	$68	26%	—	$159 – $348
24	AMH Cath Labs LLC Arlington, TX fee schedule · outpatient	4	$23	$42	$33	79%	—	$22 – $99
25	AMH Cath Labs LLC Arlington, TX percent of total billed charges · outpatientfrom % of charges	1	$8	$37	$40	109%	—	$8 – $93

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HCPCS J0650