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 14MCG/24Hr Iud
Low
$0
Average
$2.2k
Median
$1.5k
High
$10.9k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
62 hospitals; the 90th percentile is 50.3× 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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68 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 | Bay Park Community Hospital Oregon, OH facility · fee schedule · outpatient | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 2 | CORNING HOSPITAL Corning, NY facility · other · outpatient | 2 | $1.1k | $1.1k | $198 | 18% | — | $920 – $1.3k |
| 3 | CentraState Medical Center Freehold Township, NJ fee schedule · outpatient | 2 | $99 | $99 | $5 | 5% | — | $94 – $105 |
| 4 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 5 | Chilton Medical Center Pompton Plains, NJ fee schedule · outpatient | 2 | $99 | $99 | $2 | 2% | — | $97 – $101 |
| 6 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $994 | $994 | $0 | 0% | — | $994 – $994 |
| 7 | Durant HMA LLC Durant, OK facility · fee schedule · outpatient | 1 | $5.7k | $5.7k | — | — | — | $5.7k – $5.7k |
| 8 | Fisher-Titus Medical Center Norwalk, OH professional · percent of total billed charges · inpatientfrom % of charges | 1 | $828 | $828 | — | — | — | $828 – $828 |
| 9 | Fisher-Titus Medical Center Norwalk, OH professional · percent of total billed charges · outpatientfrom % of charges | 1 | $776 | $776 | — | — | — | $776 – $776 |
| 10 | GRITMAN MEDICAL CENTER INC Moscow, ID facility · fee schedule · both | 1 | $476 | $476 | — | — | — | $476 – $476 |
| 11 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient | 1 | $1.1k | $1.1k | $198 | 18% | — | $920 – $1.3k |
| 12 | Glenwood Regional Medical Center - HSA West Monroe, LA facility · fee schedule · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 13 | HMA Santa Rosa Medical Center LLC Milton, FL facility · fee schedule · outpatient | 1 | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 14 | HOULTON REGIONAL HOSPITAL HOULTON, ME percent of total billed charges · bothfrom % of charges | 1 | $868 | $868 | — | — | — | $868 – $868 |
| 15 | HSA CGH LLC Coral Gables, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $6.2k | $6.2k | — | — | — | $6.2k – $6.2k |
| 16 | HSA PGH LLC Hialeah, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $6.2k | $6.2k | — | — | — | $6.2k – $6.2k |
| 17 | Hackettstown Medical Center Hackettstown, NJ fee schedule · outpatient | 2 | $99 | $99 | $2 | 2% | — | $97 – $101 |
| 18 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $797 | $797 | — | — | — | $797 – $797 |
| 19 | Knox Hospital Company LLC Knox, IN facility · fee schedule · outpatient | 1 | $10.9k | $10.9k | — | — | — | $10.9k – $10.9k |
| 20 | La Porte Hospital Company LLC La Porte, IN facility · fee schedule · outpatient | 1 | $9.2k | $9.2k | — | — | — | $9.2k – $9.2k |
| 21 | MCLAREN CARO REGION CARO, MI fee schedule | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 22 | MCLAREN THUMB REGION AXE, MI fee schedule | 1 | $1.2k | $1.2k | — | — | — | $1.2k – $1.2k |
| 23 | Mat-Su Valley Medical Center LLC Palmer, AK facility · fee schedule · outpatient | 1 | $4.1k | $4.1k | — | — | — | $4.1k – $4.1k |
| 24 | Mayo Clinic Health System Cannon Falls 55009-5003 facility · percent of total billed charges · bothfrom % of charges | 1 | $951 | $951 | — | — | — | $951 – $951 |
| 25 | MedStar Franklin Square Medical Center Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
← Payers reporting HCPCS J7301 · Snapshot 20261111T120946Z-9134e7f7