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
$14
Average
$55
Median
$59
High
$103
Each hospital's average WellCare rate, under the methodology and billing class chosen below.
11 hospitals; the 90th percentile is 4.4× 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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12 hospital rates
iThe hospitals that file a WellCare 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 | Children's Hospital Medical Center Mason, OH percent of total billed charges · outpatientfrom % of charges | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 2 | Forsyth Memorial Hospital, Inc. Winston-Salem, NC fee schedule · outpatient | 1 | $65 | $65 | — | — | — | $65 – $65 |
| 3 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · case rate · outpatient | 1 | $20 | $20 | — | — | — | $20 – $20 |
| 4 | Lexington Medical Center Lexington, NC percent of total billed charges · outpatientfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 5 | Margaretville Memorial Hospital Margaretville, NY facility · fee schedule · outpatient | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 6 | Montefiore Medical Center Bronx, NY fee schedule · outpatient | 2 | $88 | $88 | — | — | — | $88 – $88 |
| 7 | Montefiore Mount Vernon Hospital Mount Vernon, NY fee schedule · outpatient | 2 | $88 | $88 | $0 | 0% | — | $88 – $89 |
| 8 | North Carolina Baptist Hospital Winston Salem, NC percent of total billed charges · outpatientfrom % of charges | 1 | $45 | $45 | $22 | 49% | — | $23 – $67 |
| 9 | North Carolina Baptist Hospital Bermuda Run, NC percent of total billed charges · outpatientfrom % of charges | 1 | $44 | $44 | $23 | 52% | — | $22 – $67 |
| 10 | Vanderbilt University Medical Center Nashville, TN other · both | 2 | $0 | $0 | — | — | — | $0 – $0 |
| 11 | Vanderbilt University Medical Center Nashville, TN percent of total billed charges · bothfrom % of charges | 1 | $42 | $42 | — | — | — | $42 – $42 |
| 12 | Yale New Haven Hospital Haven, CT fee schedule · outpatient | 1 | $59 | $59 | — | — | — | $59 – $59 |
← Payers reporting HCPCS V5020 · Snapshot 20261111T120946Z-9134e7f7