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 Ambetter 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.
Filter by billing methodology
Filter by billing class
393 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Advocate Childrens Hospital Oak Lawn Oak Lawn, IL facility · case rate · outpatient | 1 | $194.79 | $194.79 – $194.79 |
| 2 | Advocate Childrens Hospital Park Ridge Park Ridge, IL facility · case rate · outpatient | 1 | $194.79 | $194.79 – $194.79 |
| 3 | Advocate Christ Medical Center Oak Lawn, IL facility · case rate · outpatient | 1 | $194.79 | $194.79 – $194.79 |
| 4 | Advocate Condell Medical Center Libertyville, IL case rate · outpatient | 1 | $194.79 | $194.79 – $194.79 |
| 5 | Advocate Good Samaritan Hospital Downers Grove, IL case rate · outpatient | 1 | $194.79 | $194.79 – $194.79 |
| 6 | Advocate Good Shepherd Hospital Barrington, IL case rate · outpatient | 1 | $194.79 | $194.79 – $194.79 |
| 7 | Advocate Illinois Masonic Medical Center Chicago, IL case rate · outpatient | 1 | $194.79 | $194.79 – $194.79 |
| 8 | Advocate Lutheran General Hospital Park Ridge, IL case rate · outpatient | 1 | $194.79 | $194.79 – $194.79 |
| 9 | Advocate Sherman Hospital Elgin, IL case rate · outpatient | 1 | $194.79 | $194.79 – $194.79 |
| 10 | Advocate South Suburban Hospital Hazel Crest, IL case rate · outpatient | 1 | $194.79 | $194.79 – $194.79 |
| 11 | Advocate Trinity Hospital Chicago, IL case rate · outpatient | 1 | $194.79 | $194.79 – $194.79 |
| 12 | Alleghany County Memorial Hospital, Inc Sparta, NC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $85.00 | $85.00 – $85.00 |
| 13 | Atrium Health Hospitals Inc Kings Mountain, NC percent of total billed charges · outpatientfrom % of charges | 2 | $166.62 | $59.17 – $388.17 |
| 14 | Atrium Health Hospitals Inc Lincolnton, NC percent of total billed charges · inpatientfrom % of charges | 2 | $172.63 | $62.06 – $397.80 |
| 15 | Atrium Health Hospitals Inc Lincolnton, NC percent of total billed charges · outpatientfrom % of charges | 2 | $170.70 | $60.60 – $397.80 |
| 16 | Atrium Health Hospitals Inc Wadesboro, NC percent of total billed charges · inpatientfrom % of charges | 2 | $168.85 | $59.19 – $397.80 |
| 17 | Atrium Health Hospitals Inc Wadesboro, NC percent of total billed charges · outpatientfrom % of charges | 2 | $165.52 | $56.67 – $397.80 |
| 18 | BAPTIST HEALTHCARE SYSTEM INC Elizabethtown, KY other · both | 2 | $934.88 | $934.88 – $934.88 |
| 19 | BAPTIST HEALTHCARE SYSTEM INC Elizabethtown, KY other · outpatient | 2 | $820.29 | $35.82 – $1,523 |
| 20 | BAPTIST HEALTHCARE SYSTEM INC Albany, IN other · both | 1 | $728.10 | $728.10 – $728.10 |
| 21 | BAPTIST HEALTHCARE SYSTEM INC Albany, IN other · outpatient | 1 | $638.86 | $27.90 – $1,186 |
| 22 | BAPTIST HEALTHCARE SYSTEM INC Corbin, KY other · both | 2 | $934.88 | $934.88 – $934.88 |
| 23 | BAPTIST HEALTHCARE SYSTEM INC Corbin, KY other · outpatient | 2 | $820.29 | $35.82 – $1,523 |
| 24 | BAPTIST HEALTHCARE SYSTEM INC Lexington, KY other · both | 2 | $986.82 | $986.82 – $986.82 |
| 25 | BAPTIST HEALTHCARE SYSTEM INC Lexington, KY other · outpatient | 2 | $865.86 | $37.81 – $1,608 |
← Payers reporting HCPCS G0463 · Snapshot 20261108T203506Z-bb90dbab