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 Amerihealth Caritas 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
67 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Alleghany County Memorial Hospital, Inc Sparta, NC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $85.00 | $85.00 – $85.00 |
| 2 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $132.27 | $132.27 – $132.27 |
| 3 | Atrium Health Hospitals Inc Kings Mountain, NC percent of total billed charges · outpatientfrom % of charges | 1 | $68.90 | $26.14 – $150.89 |
| 4 | Atrium Health Hospitals Inc Lincolnton, NC percent of total billed charges · outpatientfrom % of charges | 1 | $55.08 | $20.90 – $120.62 |
| 5 | Atrium Health Hospitals Inc Wadesboro, NC percent of total billed charges · outpatientfrom % of charges | 1 | $73.06 | $27.71 – $159.97 |
| 6 | Bayhealth Hospital, Sussex Campus Milton, DE fee schedule · outpatient | 1 | $146.75 | $146.75 – $146.75 |
| 7 | Bayhealth Medical Center, Kent Campus Dover, DE fee schedule · outpatient | 1 | $151.44 | $151.44 – $151.44 |
| 8 | Camden-Clark Memorial Hospital Corporation Parkersburg, WV facility · other · outpatient | 1 | $76.90 | $51.40 – $127.91 |
| 9 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $106.51 | $40.40 – $233.23 |
| 10 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $106.51 | $40.40 – $233.23 |
| 11 | Carolinas Medical Center Davidson, NC percent of total billed charges · outpatientfrom % of charges | 1 | $106.51 | $40.40 – $233.23 |
| 12 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $106.51 | $40.40 – $233.23 |
| 13 | CentraState Medical Center Freehold Township, NJ other · outpatient | 1 | $151.03 | $151.03 – $151.03 |
| 14 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 1 | $98.36 | $98.36 – $98.36 |
| 15 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 1 | $151.03 | $151.03 – $151.03 |
| 16 | Coshocton Regional Medical Center Coshocton, OH fee schedule · outpatient | 1 | $94.98 | $94.98 – $94.98 |
| 17 | Diley Ridge Medical Center Canal Winchester, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $317.00 | $165.00 – $590.00 |
| 18 | East Liverpool City Hospital Liverpool, OH fee schedule · outpatient | 1 | $96.95 | $96.95 – $96.95 |
| 19 | HIGHLANDS-CASHIERS HOSPITAL Highlands, NC percent of total billed charges · outpatientfrom % of charges | 1 | $68.32 | $68.32 – $68.32 |
| 20 | HSA PGH LLC Hialeah, FL facility · fee schedule · outpatient | 3 | $189.91 | $131.78 – $298.91 |
| 21 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 1 | $151.03 | $151.03 – $151.03 |
| 22 | Henry Ford Health System West Bloomfield, MI facility · fee schedule · outpatient | 1 | $130.01 | $130.01 – $130.01 |
| 23 | Henry Ford Health System Plymouth, MI facility · fee schedule · outpatient | 1 | $130.01 | $130.01 – $130.01 |
| 24 | Henry Ford Macomb Hospital Corporation Clinton Twp, MI facility · fee schedule · outpatient | 1 | $130.01 | $130.01 – $130.01 |
| 25 | Henry Ford Wyandotte Hospital Brownstown Charter Twp., MI facility · fee schedule · outpatient | 1 | $130.01 | $130.01 – $130.01 |
← Payers reporting HCPCS G0463 · Snapshot 20261108T203506Z-bb90dbab