Norethindrone and ethinyl estradiol oral tablet

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

LEVONORGESTREL 1.5 MG PO TAB

Payers reporting HCPCS S4993

Payer pricing summary

Low

Average

$51

Median

$34

High

$191

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Blue Cross Blue Shield fee schedule · outpatient · +11 other terms	136	$1	$4	$23	636%	—	$0 – $278
2	Aetna fee schedule · outpatient · +13 other terms	90	$2	$5	$25	493%	—	$1 – $259
3	Superior Healthplan percent of total billed charges · outpatientfrom % of charges	34	$14	$13	$9	76%	—	$0 – $32
4	Bcbs Tx fee schedule · outpatient · +1 other terms	30	$1	$1	$0	33%	—	$0 – $1
5	UnitedHealthcare fee schedule · both · +15 other terms	27	$1	$1	$0	35%	—	$1 – $2
6	Anthem facility · fee schedule · outpatient · +10 other terms	25	$2	$7	$21	308%	—	$1 – $107
7	Cigna facility · fee schedule · outpatient · +9 other terms	20	$4	$8	$13	175%	—	$2 – $76
8	Healthcare Highways percent of total billed charges · outpatientfrom % of charges	16	$77	$73	$31	42%	—	$2 – $106
9	Caresource facility · case rate · outpatient · +4 other terms	15	$48	$52	$12	23%	—	$32 – $82
10	Molina facility · case rate · outpatient · +8 other terms	15	$47	$52	$12	23%	—	$33 – $80
11	Medical Mutual facility · percent of total billed charges · outpatientfrom % of charges · +1 other terms	13	$50	$56	$76	136%	—	$2 – $411
12	Wellmark fee schedule · both · +2 other terms	13	$1	$1	—	—	—	$1 – $1
13	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$90	$67	$38	57%	—	$28 – $112
14	Bcbs Nj fee schedule · outpatient	12	$1	$1	—	—	—	$1 – $1
15	Highmark fee schedule · outpatient · +3 other terms	11	$1	$1	$1	87%	—	$1 – $14
16	Optum facility · case rate · outpatient · +4 other terms	11	$45	$49	$11	22%	—	$40 – $73
17	Medica fee schedule · outpatient · +5 other terms	10	$2	$2	$0	25%	—	$1 – $2
18	Ucare fee schedule · both · +1 other terms	9	$28	$28	$1	3%	—	$27 – $29
19	WellCare percent of total billed charges · outpatientfrom % of charges · +1 other terms	9	$17	$33	$42	128%	—	$1 – $160
20	Aetna Better Health fee schedule · outpatient · +4 other terms	8	$1	$1	$0	2%	—	$1 – $1
21	Medcost percent of total billed charges · outpatientfrom % of charges · +2 other terms	7	$60	$61	$37	61%	—	$10 – $189
22	Excellus facility · fee schedule · outpatient · +2 other terms	5	$2	$2	$2	79%	—	$1 – $6
23	Humana fee schedule · inpatient · +11 other terms	5	$1	$1	—	—	—	$1 – $1
24	Medicare facility · percent of total billed charges · outpatientfrom % of charges	5	$0	$0	$0	7%	—	$0 – $1
25	Ambetter percent of total billed charges · outpatientfrom % of charges · +2 other terms	4	$15	$40	$47	115%	—	$2 – $119

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