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
LEVONORGESTREL 17.5 MCG/24 HR (UP TO 5 YRS) 19.5MG INTRAUTERINE DEVICE
Low
$0
Average
$1.5k
Median
$1.2k
High
$9.9k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
217 hospitals; the 90th percentile is 8.6× 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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278 hospital rates
iThe hospitals that file a Molina 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 | Public Hospital District No 1 of Mason County Shelton, WA fee schedule · both | 1 | $1.3k | $1.3k | — | — | 2–20 | $1.3k – $1.3k |
| 2 | HOLLAND COMMUNITY HOSPITAL Holland, MI percent of total billed charges · outpatientfrom % of charges | 1 | $412 | $412 | — | — | 1–10 | $412 – $412 |
| 3 | Self Regional Healthcare Greenwood, SC facility · other · outpatient | 1 | $2.6k | $2.6k | — | — | 1–10 | $2.6k – $2.6k |
| 4 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $637 | $637 | — | — | — | $637 – $637 |
| 5 | AMH Cath Labs LLC Arlington, TX percent of total billed charges · outpatientfrom % of charges | 1 | $376 | $376 | — | — | — | $376 – $376 |
| 6 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH per diem · inpatient | 2 | $5.4k | $5.4k | — | — | — | $5.4k – $5.4k |
| 7 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · inpatientfrom % of charges | 2 | $1.5k | $1.5k | $189 | 12% | — | $1.4k – $1.7k |
| 8 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · outpatientfrom % of charges | 4 | $1.2k | $1.2k | $209 | 17% | — | $931 – $1.6k |
| 9 | Adena Fayette Medical Center Washington Court House, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $1.1k | $1.1k | $357 | 32% | — | $759 – $1.5k |
| 10 | AnMed Health Anderson, SC facility · per diem · outpatient | 1 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 11 | AnMed Piedmont Piedmont, SC facility · per diem · outpatient | 1 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 12 | AnMed Piedmont Piedmont, SC professional · fee schedule · outpatient | 1 | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 13 | Appalachian Regional Healthcare, Inc. Middlesboro, KY percent of total billed charges · outpatientfrom % of charges | 1 | $928 | $928 | — | — | — | $928 – $928 |
| 14 | Appalachian Regional Healthcare, Inc. Hazard, KY percent of total billed charges · outpatientfrom % of charges | 1 | $981 | $981 | — | — | — | $981 – $981 |
| 15 | Aurora Sinai Medical Center of Aurora Health Care Metro Inc Milwaukee, WI percent of total billed charges · outpatientfrom % of charges | 1 | $3.2k | $3.2k | $1.8k | 58% | — | $1.4k – $5.0k |
| 16 | Aurora St Lukes Medical Center of Aurora Health Care Metro Inc Milwaukee, WI percent of total billed charges · outpatientfrom % of charges | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 17 | Aurora West Allis Medical Center West Allis, WI percent of total billed charges · outpatientfrom % of charges | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 18 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE fee schedule · outpatient | 1 | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 19 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE percent of total billed charges · outpatientfrom % of charges | 1 | $966 | $966 | — | — | — | $966 – $966 |
| 20 | Baptist Medical Center of Nassau, INC Yulee, FL facility · case rate · outpatient | 1 | $342 | $342 | — | — | — | $342 – $342 |
| 21 | Baptist Medical Center of the Beaches, INC Beach, FL facility · case rate · outpatient | 1 | $342 | $342 | — | — | — | $342 – $342 |
| 22 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 23 | Bexar County Hospital District San Antonio, TX fee schedule · outpatient | 1 | $938 | $938 | $313 | 33% | — | $625 – $1.3k |
| 24 | Bronson LakeView Hospital Paw Paw, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $824 | $824 | — | — | — | $824 – $824 |
| 25 | CATHOLIC HEALTH INITIATIVES COLORADO West Valley City, UT percent of total billed charges · inpatientfrom % of charges | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
← Payers reporting HCPCS J7296 · Snapshot 20261111T120946Z-9134e7f7