Theophylline injection, 400 mg

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

Inj theophylline per 40 MG

Payers reporting HCPCS J2810

Payer pricing summary

Low

Average

$33

Median

$13

High

$208

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +13 other terms	201	$1	$81	$327	403%	—	$0 – $1.4k
2	Cigna fee schedule · outpatient · +12 other terms	195	$1	$2	$7	338%	—	$0 – $71
3	Blue Cross Blue Shield fee schedule · outpatient · +13 other terms	172	$1	$2	$5	226%	—	$0 – $66
4	Aetna fee schedule · outpatient · +14 other terms	99	$1	$2	$8	465%	—	$0 – $63
5	Humana fee schedule · outpatient · +8 other terms	72	$2	$2	$2	87%	—	$0 – $12
6	Anthem fee schedule · outpatient · +10 other terms	40	$0	$1	$6	607%	—	$0 – $56
7	Bcbs Tx fee schedule · outpatient · +1 other terms	30	$2	$2	$1	33%	—	$1 – $3
8	Baylor Scott White Health Plan facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	26	$16	$14	$2	16%	—	$11 – $17
9	Superior Healthplan facility · percent of total billed charges · outpatientfrom % of charges	25	$4	$4	$1	32%	—	$2 – $7
10	Caresource facility · case rate · outpatient · +4 other terms	15	$9	$10	$2	23%	—	$6 – $15
11	Medica fee schedule · outpatient · +7 other terms	15	$2	$34	$125	369%	—	$1 – $555
12	Molina facility · case rate · outpatient · +8 other terms	15	$9	$10	$2	23%	—	$6 – $15
13	Ambetter facility · percent of total billed charges · outpatientfrom % of charges	13	$16	$16	—	—	—	$16 – $16
14	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$0	$0	$0	26%	—	$0 – $0
15	Highmark fee schedule · outpatient · +3 other terms	12	$0	$0	$0	2%	—	$0 – $0
16	Optum facility · case rate · outpatient · +4 other terms	11	$8	$9	$2	22%	—	$7 – $13
17	Bcbs Nj fee schedule · outpatient	10	$0	$0	—	—	—	$0 – $0
18	Ucare fee schedule · both · +2 other terms	9	$0	$0	$0	2%	—	$0 – $0
19	Phcs percent of total billed charges · bothfrom % of charges · +2 other terms	8	$55	$55	—	—	—	$55 – $55
20	Bcbs La fee schedule · outpatient · +1 other terms	6	$0	$0	—	—	—	$0 – $0
21	Devoted facility · fee schedule · outpatient	5	$2	$2	—	—	—	$2 – $2
22	MultiPlan fee schedule · inpatient · +8 other terms	5	$57	$79	$40	50%	—	$49 – $154
23	Oscar percent of total billed charges · inpatientfrom % of charges · +1 other terms	5	$104	$104	—	—	—	$104 – $104
24	Tricare fee schedule · outpatient	5	$208	$208	—	—	—	$208 – $208
25	Aetna Better Health facility · percent of total billed charges · outpatientfrom % of charges · +2 other terms	4	$105	$101	$77	76%	—	$22 – $184

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