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.
Original text from hospital filings
LEVSIN 0.5MG/ML 1ML AMP
Low
$29
Average
$332
Median
$389
High
$564
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
23 hospitals; the 90th percentile is 6.1× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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23 hospital rates
iThe hospitals that file a Tricare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 2 | Baptist Medical Center-Attala Kosciusko, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $208 | $208 | — | — | — | $208 – $208 |
| 3 | Baptist Medical Center-Yazoo Yazoo City, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $202 | $202 | — | — | — | $202 – $202 |
| 4 | Baptist Memorial Hospital - Leake Carthage, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $202 | $202 | — | — | — | $202 – $202 |
| 5 | Baptist Memorial Hospital-Calhoun Calhoun City, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $255 | $255 | — | — | — | $255 – $255 |
| 6 | CLEVELAND AREA HOSPITAL CLEVELAND, OK percent of total billed charges · bothfrom % of charges | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 7 | Conway Regional Medical Center Conway, AR facility · fee schedule · outpatient | 1 | $453 | $453 | $78 | 17% | — | $375 – $531 |
| 8 | HSA CGH LLC Coral Gables, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $544 | $544 | — | — | — | $544 – $544 |
| 9 | HSA PGH LLC Hialeah, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $544 | $544 | — | — | — | $544 – $544 |
| 10 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $36 | $83 | $58 | 70% | — | $35 – $159 |
| 11 | MACON COMMUNITY HOSPITAL LAFAYETTE, TN percent of total billed charges · bothfrom % of charges | 1 | $29 | $29 | — | — | — | $29 – $29 |
| 12 | Mid Hudson Regional Hospital Poughkeepsie, NY facility · fee schedule · outpatient | 1 | $132 | $132 | $22 | 17% | — | $110 – $154 |
| 13 | Northside Hospital, Inc. Lawrenceville, GA fee schedule · outpatient | 1 | $564 | $564 | — | — | — | $564 – $564 |
| 14 | Northside Hospital, Inc. Atlanta, GA fee schedule · outpatient | 1 | $564 | $564 | — | — | — | $564 – $564 |
| 15 | Northside Hospital, Inc. Cumming, GA fee schedule · outpatient | 1 | $564 | $564 | — | — | — | $564 – $564 |
| 16 | Northside Hospital, Inc. Duluth, GA fee schedule · outpatient | 1 | $564 | $564 | — | — | — | $564 – $564 |
| 17 | Northside Hospital, Inc. Canton, GA fee schedule · outpatient | 1 | $564 | $564 | — | — | — | $564 – $564 |
| 18 | Penn Medicine Princeton Medical Center Princeton, NJ facility · fee schedule · outpatient | 1 | $389 | $389 | — | — | — | $389 – $389 |
| 19 | Pennsylvania Hospital of the University of Pennsylvania Health System Philadelphia, PA facility · fee schedule · outpatient | 1 | $389 | $389 | — | — | — | $389 – $389 |
| 20 | Presbyterian Medical Center of the University of Pennsylvania Health System D/B/A Penn Presbyterian Medical Center Philadelphia, PA facility · fee schedule · outpatient | 1 | $389 | $389 | — | — | — | $389 – $389 |
| 21 | The Chester County Hospital West Chester, PA facility · fee schedule · outpatient | 1 | $389 | $389 | — | — | — | $389 – $389 |
| 22 | The Trustees of the University of Pennsylvania D/B/A The Hospital of the University of Pennsylvania Philadelphia, PA facility · fee schedule · outpatient | 1 | $241 | $276 | $82 | 30% | — | $198 – $389 |
| 23 | Westchester Medical Center Valhalla, NY facility · fee schedule · outpatient | 1 | $132 | $132 | $22 | 17% | — | $110 – $154 |
← Payers reporting HCPCS J1980 · Snapshot 20261111T120946Z-9134e7f7