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 Better Health 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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112 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | ACADIAN MEDICAL CENTER EUNICE, LA percent of total billed charges · bothfrom % of charges | 2 | $91.55 | $28.44 – $175.01 |
| 2 | ARH Mary Breckinridge Health Services, Inc Barbourville, KY percent of total billed charges · outpatientfrom % of charges | 1 | $43.86 | $43.86 – $43.86 |
| 3 | ARH Mary Breckinridge Health Services, Inc Hayden, KY percent of total billed charges · outpatientfrom % of charges | 1 | $38.70 | $38.70 – $38.70 |
| 4 | ARH Mary Breckinridge Health Services, Inc Martin, KY percent of total billed charges · outpatientfrom % of charges | 1 | $51.60 | $51.60 – $51.60 |
| 5 | Appalachian Regional Healthcare, Inc. Liberty, KY percent of total billed charges · outpatientfrom % of charges | 1 | $54.18 | $54.18 – $54.18 |
| 6 | Appalachian Regional Healthcare, Inc. McDowell, KY percent of total billed charges · outpatientfrom % of charges | 1 | $43.86 | $43.86 – $43.86 |
| 7 | BELTON REGIONAL MEDICAL CENTER Kansas City, MO fee schedule · outpatient | 1 | $54.08 | $54.08 – $54.08 |
| 8 | Camden-Clark Memorial Hospital Corporation Parkersburg, WV facility · other · outpatient | 1 | $141.32 | $141.32 – $141.32 |
| 9 | Carle BroMenn Medical Center Normal, IL fee schedule · inpatient | 1 | $89.97 | $89.97 – $89.97 |
| 10 | Carle BroMenn Medical Center Normal, IL fee schedule · outpatient | 1 | $89.97 | $89.97 – $89.97 |
| 11 | Carle BroMenn Medical Center Normal, IL other · outpatient | 1 | $110.72 | $110.72 – $110.72 |
| 12 | Carle Eureka Hospital Eureka, IL fee schedule · inpatient | 1 | $89.97 | $89.97 – $89.97 |
| 13 | Carle Eureka Hospital Eureka, IL fee schedule · outpatient | 1 | $89.97 | $89.97 – $89.97 |
| 14 | CentraState Medical Center Freehold Township, NJ per diem · outpatient | 1 | $87.24 | $87.24 – $87.24 |
| 15 | Charleston Area Medical Center Charleston, WV fee schedule · both | 1 | $65.45 | $19.64 – $129.01 |
| 16 | Charleston Area Medical Center Charleston, WV fee schedule · outpatient | 1 | $59.13 | $19.64 – $129.01 |
| 17 | Charleston Area Medical Center Charleston, WV percent of total billed charges · outpatientfrom % of charges | 1 | $68.06 | $68.06 – $68.06 |
| 18 | Chilton Medical Center Pompton Plains, NJ per diem · outpatient | 1 | $95.17 | $95.17 – $95.17 |
| 19 | Community Health Association Ripley, WV facility · percent of total billed charges · outpatientfrom % of charges | 1 | $37.75 | $37.75 – $37.75 |
| 20 | Deaconess Health System Henderson Hospital Henderson, KY facility · percent of total billed charges · outpatientfrom % of charges | 1 | $33.00 | $30.80 – $40.60 |
| 21 | Deaconess Health System Union County Hospital Morganfield, KY facility · percent of total billed charges · outpatientfrom % of charges | 1 | $72.73 | $46.02 – $130.49 |
| 22 | Deaconess Hospital, Inc Newburgh, IN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $41.25 | $38.50 – $50.75 |
| 23 | Deaconess Hospital, Inc Newburgh, IN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $108.46 | $42.46 – $151.12 |
| 24 | Deaconess Illinois Crossroads Inc Mount Vernon, IL facility · case rate · outpatient | 1 | $137.02 | $137.02 – $137.02 |
| 25 | Deaconess Illinois Union County Hospital Inc Anna, IL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $50.35 | $50.35 – $50.35 |
← Payers reporting HCPCS G0463 · Snapshot 20261108T203506Z-bb90dbab