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
Est Eval Visit Level 5 - Psych|PROCEDURE PERFORMED ON INFANTS LESS THAN 4 KG
The hospitals that file a Aetna 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.
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2,217 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | AHS Hillcrest Medical Center, LLC Tulsa, OK facility · percent of total billed charges · bothfrom % of charges | 2 | $627.95 | $437.24 – $943.85 |
| 2 | AHS Southcrest Hospital, LLC Tulsa, OK facility · percent of total billed charges · bothfrom % of charges | 2 | $364.11 | $263.40 – $465.34 |
| 3 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · fee schedule · outpatient | 1 | $125.96 | $125.96 – $125.96 |
| 4 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · other · outpatient | 3 | $55.10 | $48.59 – $60.00 |
| 5 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · percent of total billed charges · outpatientfrom % of charges | 2 | $450.63 | $386.25 – $515.00 |
| 6 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · fee schedule · outpatient | 1 | $160.12 | $160.12 – $160.12 |
| 7 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient | 6 | $87.35 | $87.35 – $87.35 |
| 8 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 2 | $220.92 | $128.93 – $312.91 |
| 9 | ARH Mary Breckinridge Health Services, Inc Barbourville, KY percent of total billed charges · bothfrom % of charges | 1 | $227.04 | $227.04 – $227.04 |
| 10 | ARH Mary Breckinridge Health Services, Inc Barbourville, KY percent of total billed charges · outpatientfrom % of charges | 1 | $61.92 | $61.92 – $61.92 |
| 11 | ARH Mary Breckinridge Health Services, Inc Hayden, KY percent of total billed charges · bothfrom % of charges | 1 | $227.04 | $227.04 – $227.04 |
| 12 | ARH Mary Breckinridge Health Services, Inc Hayden, KY percent of total billed charges · outpatientfrom % of charges | 1 | $54.18 | $54.18 – $54.18 |
| 13 | ARH Mary Breckinridge Health Services, Inc Martin, KY percent of total billed charges · bothfrom % of charges | 1 | $227.04 | $227.04 – $227.04 |
| 14 | ARH Mary Breckinridge Health Services, Inc Martin, KY percent of total billed charges · outpatientfrom % of charges | 1 | $67.08 | $67.08 – $67.08 |
| 15 | ATHOL MEMORIAL HOSPITAL INCORPORATED Athol, MA percent of total billed charges · outpatientfrom % of charges | 1 | $87.67 | $87.67 – $87.67 |
| 16 | Acadia Hospital Bangor, ME facility · case rate · outpatient | 1 | $127.22 | $127.22 – $127.22 |
| 17 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 1 | $81.16 | $81.16 – $81.16 |
| 18 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 1 | $127.12 | $127.12 – $127.12 |
| 19 | AdventHealth Avista Louisville, CO fee schedule · outpatient | 1 | $142.00 | $142.00 – $142.00 |
| 20 | AdventHealth Deland Deland, FL fee schedule · outpatient | 1 | $148.76 | $148.76 – $148.76 |
| 21 | AdventHealth Littleton Littleton, CO fee schedule · outpatient | 1 | $140.44 | $140.44 – $140.44 |
| 22 | AdventHealth New Smyrna Beach New Smyrna Beach, FL fee schedule · outpatient | 1 | $148.76 | $148.76 – $148.76 |
| 23 | AdventHealth Orlando Winter Park, FL fee schedule · outpatient | 1 | $148.76 | $148.76 – $148.76 |
| 24 | AdventHealth Parker Aurora, CO fee schedule · outpatient | 1 | $140.44 | $140.44 – $140.44 |
| 25 | AdventHealth Porter Denver, CO fee schedule · outpatient | 1 | $140.44 | $140.44 – $140.44 |
← Payers reporting HCPCS G0463 · Snapshot 20261108T203506Z-bb90dbab