Hormonal contraceptive patch, each

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

NORELGESTROMIN 150 MCG-E.ESTRADIOL 35 MCG/24 HR WEEKLY TRANSDERM PATCH

Payers reporting HCPCS J7304

Payer pricing summary

Low

$36

Average

$112

Median

$78

High

$580

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Blue Cross Blue Shield fee schedule · outpatient · +13 other terms	141	$84	$103	$62	60%	—	$0 – $280
2	Aetna fee schedule · outpatient · +17 other terms	113	$76	$88	$65	74%	—	$33 – $423
3	Humana fee schedule · outpatient · +15 other terms	74	$151	$226	$137	61%	—	$39 – $407
4	UnitedHealthcare fee schedule · outpatient · +18 other terms	50	$43	$47	$24	51%	—	$18 – $145
5	Bcbs Tx fee schedule · outpatient · +1 other terms	30	$176	$160	$53	33%	—	$66 – $277
6	Molina facility · case rate · outpatient · +13 other terms	28	$121	$111	$41	36%	—	$56 – $218
7	Anthem facility · fee schedule · outpatient · +11 other terms	26	$43	$74	$56	76%	—	$21 – $286
8	Cigna facility · fee schedule · outpatient · +12 other terms	19	$42	$6.7k	$34.0k	506%	—	$0 – $180.0k
9	Bcbs La fee schedule · outpatient · +2 other terms	16	$48	$48	—	—	—	$48 – $48
10	Caresource facility · case rate · outpatient · +2 other terms	16	$129	$129	$44	34%	—	$43 – $222
11	Aetna Better Health fee schedule · outpatient · +4 other terms	13	$40	$41	$1	3%	—	$40 – $42
12	Optum facility · case rate · outpatient · +6 other terms	13	$116	$122	$37	31%	—	$62 – $197
13	Wellmark fee schedule · both · +3 other terms	13	$41	$41	—	—	—	$41 – $41
14	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$51	$48	$14	29%	—	$26 – $63
15	Amerihealth Caritas other · outpatient · +5 other terms	10	$20	$25	$31	123%	—	$11 – $184
16	Bcbs Nj fee schedule · outpatient	10	$42	$42	—	—	—	$42 – $42
17	Medica fee schedule · outpatient · +6 other terms	10	$85	$86	$21	25%	—	$52 – $110
18	Ucare fee schedule · both · +3 other terms	9	$35	$35	$1	3%	—	$34 – $36
19	Carefirst percent of total billed charges · outpatientfrom % of charges · +2 other terms	7	$102	$101	$36	35%	—	$54 – $157
20	Cigna Healthspring percent of total billed charges · outpatientfrom % of charges	7	$102	$101	$36	35%	—	$54 – $157
21	Phcs percent of total billed charges · outpatientfrom % of charges · +2 other terms	7	$102	$101	$36	35%	—	$54 – $157
22	Excellus facility · fee schedule · outpatient	5	$69	$78	$48	62%	—	$43 – $202
23	MultiPlan other · outpatient · +9 other terms	5	$55	$65	$27	41%	—	$38 – $121
24	First Health other · inpatient · +10 other terms	4	$78	$60	$30	49%	—	$41 – $111
25	Medicaid case rate · outpatient · +2 other terms	4	$133	$132	$23	17%	—	$106 – $156

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