Follitropin alfa injection, 75 IU

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

Injection, follitropin alfa, 75 IU

Payers reporting HCPCS S0126

Payer pricing summary

Low

$65

Average

$2.0k

Median

$436

High

$10.4k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Cigna fee schedule · outpatient · +9 other terms	183	$461	$750	$539	72%	—	$143 – $2.1k
2	Blue Cross Blue Shield fee schedule · outpatient · +11 other terms	164	$447	$537	$320	60%	—	$1 – $1.6k
3	Aetna fee schedule · outpatient · +14 other terms	110	$350	$484	$307	63%	—	$144 – $2.5k
4	Humana fee schedule · outpatient · +11 other terms	75	$232	$325	$197	61%	—	$63 – $589
5	Kaiser fee schedule · both · +1 other terms	43	$93	$88	$24	27%	—	$64 – $127
6	Anthem fee schedule · outpatient · +7 other terms	39	$266	$402	$188	47%	—	$129 – $1.1k
7	UnitedHealthcare fee schedule · outpatient · +13 other terms	31	$327	$361	$173	48%	—	$144 – $686
8	Bcbs Tx fee schedule · outpatient · +1 other terms	30	$792	$720	$240	33%	—	$294 – $1.2k
9	Molina facility · case rate · outpatient · +7 other terms	29	$121	$110	$41	37%	—	$56 – $218
10	Caresource facility · case rate · outpatient · +1 other terms	15	$131	$141	$32	23%	—	$87 – $222
11	Optum facility · case rate · outpatient · +2 other terms	13	$116	$122	$37	31%	—	$62 – $197
12	Wellmark fee schedule · both · +3 other terms	13	$242	$242	—	—	—	$242 – $242
13	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$78	$140	$85	61%	—	$39 – $251
14	Bcbs Nj fee schedule · outpatient · +3 other terms	12	$241	$241	—	—	—	$241 – $241
15	Highmark fee schedule · outpatient · +4 other terms	11	$271	$268	$19	7%	—	$130 – $294
16	Medica fee schedule · outpatient · +4 other terms	10	$490	$494	$123	25%	—	$297 – $633
17	MultiPlan percent of total billed charges · outpatientfrom % of charges · +2 other terms	8	$10.7k	$9.9k	$2.1k	21%	—	$7.1k – $12.1k
18	Aetna Better Health fee schedule · inpatient · +5 other terms	7	$239	$239	—	—	—	$239 – $239
19	Amerihealth Caritas facility · case rate · outpatient · +1 other terms	7	$72	$73	$2	3%	—	$72 – $78
20	Bcbs La fee schedule · outpatient · +1 other terms	6	$204	$207	$9	4%	—	$204 – $233
21	Excellus facility · fee schedule · outpatient	5	$391	$441	$277	63%	—	$242 – $1.2k
22	Clover facility · other · outpatient	4	$10.4k	$10.4k	—	—	—	$10.4k – $10.4k
23	First Health facility · fee schedule · outpatient · +3 other terms	4	$725	$725	—	—	—	$725 – $725
24	Tricare facility · fee schedule · outpatient	4	$10.4k	$10.4k	—	—	—	$10.4k – $10.4k
25	Bcbs Ks fee schedule · outpatient · +1 other terms	3	$278	$278	—	—	—	$278 – $278

Page 1 of 2 · 38 payers