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 Anthem 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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593 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $60.30 | $60.30 – $60.30 |
| 2 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · fee schedule · outpatient | 3 | $272.10 | $125.96 – $373.16 |
| 3 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $293.91 | $293.91 – $293.91 |
| 4 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $284.80 | $284.80 – $284.80 |
| 5 | ARH Mary Breckinridge Health Services, Inc Barbourville, KY percent of total billed charges · outpatientfrom % of charges | 3 | $132.01 | $43.86 – $225.57 |
| 6 | ARH Mary Breckinridge Health Services, Inc Hayden, KY percent of total billed charges · outpatientfrom % of charges | 3 | $129.41 | $38.70 – $225.57 |
| 7 | ARH Mary Breckinridge Health Services, Inc Martin, KY percent of total billed charges · outpatientfrom % of charges | 3 | $134.02 | $51.60 – $218.60 |
| 8 | Acadia Hospital Bangor, ME facility · case rate · outpatient | 1 | $124.72 | $124.72 – $124.72 |
| 9 | Alta Bates Summit Medical Center Oakland, CA facility · fee schedule · outpatient | 1 | $189.30 | $189.30 – $189.30 |
| 10 | Alta Bates Summit Medical Center-Summit Campus-Hawthorne Oakland, CA facility · fee schedule · outpatient | 1 | $189.30 | $189.30 – $189.30 |
| 11 | Alta Newport Hospital, LLC Tustin, CA facility · case rate · outpatient | 3 | $292.18 | $128.87 – $415.38 |
| 12 | American Hospital Management Corporation Arcata, CA facility · case rate · outpatient | 2 | $572.91 | $572.91 – $572.91 |
| 13 | Appalachian Regional Healthcare, Inc. Liberty, KY percent of total billed charges · outpatientfrom % of charges | 3 | $137.19 | $54.18 – $225.57 |
| 14 | Appalachian Regional Healthcare, Inc. McDowell, KY percent of total billed charges · outpatientfrom % of charges | 3 | $131.90 | $43.86 – $225.57 |
| 15 | Aspirus Divine Savior Hospital Portage, WI fee schedule · outpatient | 2 | $550.91 | $131.91 – $969.90 |
| 16 | Aspirus Rhinelander Hospital Rhinelander, WI fee schedule · outpatient | 2 | $550.91 | $131.91 – $969.90 |
| 17 | Aspirus St. Luke’s Hospital Duluth, MN fee schedule · outpatient | 2 | $206.76 | $137.84 – $275.68 |
| 18 | Aspirus Stevens Point Hospital Stevens Point, WI fee schedule · outpatient | 2 | $550.91 | $131.91 – $969.90 |
| 19 | Aspirus Wausau Hospital Wausau, WI fee schedule · outpatient | 2 | $553.37 | $132.50 – $974.24 |
| 20 | Aspirus Wisconsin Rapids Hospital Wisconsin Rapids, WI fee schedule · outpatient | 2 | $550.91 | $131.91 – $969.90 |
| 21 | Atrium Medical Center Middletown, OH fee schedule · outpatient | 3 | $292.04 | $183.48 – $402.81 |
| 22 | BAPTIST HEALTHCARE SYSTEM INC Elizabethtown, KY other · both | 1 | $487.83 | $487.83 – $487.83 |
| 23 | BAPTIST HEALTHCARE SYSTEM INC Elizabethtown, KY other · outpatient | 1 | $428.03 | $18.69 – $794.90 |
| 24 | BAPTIST HEALTHCARE SYSTEM INC Elizabethtown, KY percent of total billed charges · bothfrom % of charges | 6 | $158.23 | $55.97 – $188.87 |
| 25 | BAPTIST HEALTHCARE SYSTEM INC Elizabethtown, KY percent of total billed charges · outpatientfrom % of charges | 6 | $138.83 | $2.14 – $307.76 |
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