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.
Generation details were not recorded for this description.
Original text from hospital filings
Conformity Evaluation
Low
$25
Average
$195
Median
$120
High
$514
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5 hospital rates
iThe hospitals that file a Magellan 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 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL per diem · inpatient | 1 | $900 | $900 | — | — | — | $900 – $900 |
| 2 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL percent of total billed charges · outpatientfrom % of charges | 1 | $127 | $127 | $20 | 16% | — | $107 – $147 |
| 3 | Holyoke Medical Center Holyoke, MA facility · percent of total billed charges · inpatientfrom % of charges | 2 | $63 | $63 | — | — | — | $63 – $63 |
| 4 | Tufts Medical Center BOSTON, MA percent of total billed charges · bothfrom % of charges | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 5 | Yale New Haven Hospital Haven, CT fee schedule · outpatient | 1 | $177 | $177 | — | — | — | $177 – $177 |
← Payers reporting HCPCS V5020 · Snapshot 20261111T120946Z-9134e7f7