Follitropin beta 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 beta, 75 IU

Payers reporting HCPCS S0128

Payer pricing summary

Low

$53

Average

$601

Median

$254

High

$3.6k

Payer rate distribution

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#
1	Cigna fee schedule · outpatient · +8 other terms	183	$416	$671	$465	69%	—	$134 – $1.9k
2	Blue Cross Blue Shield fee schedule · outpatient · +9 other terms	164	$407	$541	$309	57%	—	$1 – $1.4k
3	Aetna fee schedule · outpatient · +10 other terms	110	$393	$459	$250	54%	—	$177 – $2.3k
4	Humana fee schedule · outpatient · +7 other terms	71	$209	$315	$188	60%	—	$60 – $559
5	Kaiser fee schedule · both · +1 other terms	43	$88	$84	$23	27%	—	$61 – $121
6	Anthem fee schedule · outpatient · +6 other terms	35	$239	$374	$170	45%	—	$121 – $1.0k
7	Bcbs Tx fee schedule · outpatient · +1 other terms	30	$819	$744	$248	33%	—	$304 – $1.3k
8	UnitedHealthcare fee schedule · outpatient · +10 other terms	27	$295	$425	$339	80%	—	$204 – $1.5k
9	MultiPlan percent of total billed charges · outpatientfrom % of charges · +1 other terms	20	$770	$2.7k	$3.3k	121%	—	$748 – $9.6k
10	Caresource facility · case rate · outpatient · +1 other terms	15	$48	$52	$12	23%	—	$32 – $82
11	Molina facility · case rate · outpatient · +5 other terms	15	$47	$52	$12	23%	—	$33 – $80
12	Wellmark fee schedule · both · +2 other terms	13	$218	$218	—	—	—	$218 – $218
13	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$420	$345	$152	44%	—	$206 – $525
14	Bcbs Nj fee schedule · outpatient	12	$217	$217	—	—	—	$217 – $217
15	Highmark fee schedule · outpatient · +3 other terms	11	$244	$239	$29	12%	—	$43 – $248
16	Optum facility · case rate · outpatient · +1 other terms	11	$45	$49	$11	22%	—	$40 – $73
17	Medica fee schedule · outpatient · +4 other terms	10	$441	$445	$111	25%	—	$268 – $570
18	Aetna Better Health fee schedule · inpatient · +3 other terms	7	$215	$215	—	—	—	$215 – $215
19	Bcbs La fee schedule · outpatient · +1 other terms	6	$172	$176	$12	7%	—	$172 – $210
20	Excellus facility · fee schedule · outpatient	5	$352	$397	$250	63%	—	$218 – $1.0k
21	First Health facility · fee schedule · outpatient · +1 other terms	4	$653	$653	—	—	—	$653 – $653
22	Bcbs Ks fee schedule · outpatient · +1 other terms	3	$251	$251	—	—	—	$251 – $251
23	Sanford Health Plan fee schedule · outpatient · +1 other terms	3	$222	$222	—	—	—	$222 – $222
24	Bcbs Ca fee schedule · outpatient · +1 other terms	1	$222	$222	—	—	—	$222 – $222
25	Bcbs Id professional · fee schedule · outpatient	1	$222	$222	—	—	—	$222 – $222

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