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 1.5 MG PO TAB
Low
$1
Average
$63
Median
$28
High
$419
Each hospital's average Cigna rate, under the methodology and billing class chosen below.
124 hospitals; the 90th percentile is 136.3× 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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147 hospital rates
iThe hospitals that file a Cigna 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 | ALASKA REGIONAL HOSPITAL Anchorage, AK percent of total billed charges · outpatientfrom % of charges | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 2 | ANGEL MEDICAL CENTER Franklin, NC percent of total billed charges · outpatientfrom % of charges | 4 | $32 | $37 | $9 | 24% | — | $32 – $53 |
| 3 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 1 | $76 | $76 | — | — | — | $76 – $76 |
| 4 | BLUE RIDGE REGIONAL HOSPITAL Spruce Pine, NC percent of total billed charges · outpatientfrom % of charges | 4 | $31 | $33 | $3 | 8% | — | $31 – $38 |
| 5 | BRFHH MONROE, LLC Monroe, LA other · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 6 | Blue Hill Memorial Hospital Hill, ME facility · fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 7 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 8 | CATHOLIC MEDICAL CENTER MANCHESTER, NH percent of total billed charges · outpatientfrom % of charges | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 9 | CHIPPENHAM HOSPITAL RICHMOND, VA percent of total billed charges · outpatientfrom % of charges | 3 | $18 | $19 | $4 | 20% | — | $12 – $23 |
| 10 | Charles A. Dean Memorial Hospital Greenville, ME facility · fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 11 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 12 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 2 | $6 | $6 | — | — | — | $6 – $6 |
| 13 | Children's Hospital of the King's Daughters Norfolk, VA facility · percent of total billed charges · inpatientfrom % of charges | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 14 | Children's Hospital of the King's Daughters Norfolk, VA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 15 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · fee schedule · outpatient | 3 | $4 | $4 | $0 | 4% | — | $4 – $4 |
| 16 | Eastern Maine Medical Center Bangor, ME facility · fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 17 | Eastern Maine Medical Center Bangor, ME professional · fee schedule · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 18 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $29 | $29 | $2 | 9% | — | $26 – $31 |
| 19 | HCA FLORIDA LAKE CITY HOSPITAL LAKE CITY, FL percent of total billed charges · outpatientfrom % of charges | 3 | $16 | $13 | $4 | 34% | — | $7 – $16 |
| 20 | HCA FLORIDA NORTH FLORIDA HOSPITAL GAINESVILLE, FL percent of total billed charges · outpatientfrom % of charges | 3 | $6 | $5 | $2 | 34% | — | $2 – $6 |
| 21 | HCA FLORIDA OCALA HOSPITAL OCALA, FL percent of total billed charges · outpatientfrom % of charges | 3 | $19 | $15 | $5 | 34% | — | $8 – $19 |
| 22 | HCA FLORIDA WEST MARION HOSPITAL OCALA, FL percent of total billed charges · outpatientfrom % of charges | 3 | $19 | $15 | $5 | 34% | — | $8 – $19 |
| 23 | HCA HEALTHONE SPALDING REHABILITATION AURORA, CO percent of total billed charges · outpatientfrom % of charges | 8 | $4 | $4 | $1 | 35% | — | $2 – $5 |
| 24 | HCA HOUSTON HEALTHCARE CONROE CONROE, TX percent of total billed charges · outpatientfrom % of charges | 3 | $17 | $18 | $15 | 83% | — | $3 – $38 |
| 25 | HCA HOUSTON HEALTHCARE KINGWOOD KINGWOOD, TX percent of total billed charges · outpatientfrom % of charges | 3 | $28 | $30 | $23 | 76% | — | $7 – $60 |
← Payers reporting HCPCS S4993 · Snapshot 20261111T120946Z-9134e7f7