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 Blue Cross Blue Shield 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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1,268 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | ACADIAN MEDICAL CENTER EUNICE, LA fee schedule · both | 5 | $217.88 | $217.88 – $217.88 |
| 2 | AGH LAVEEN LLC Phoenix, AZ fee schedule · outpatient | 4 | $246.89 | $138.73 – $339.49 |
| 3 | AGH MESA LLC Mesa, AZ fee schedule · outpatient | 4 | $246.89 | $138.73 – $339.49 |
| 4 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · fee schedule · outpatient | 1 | $152.50 | $152.50 – $152.50 |
| 5 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · outpatientfrom % of charges | 3 | $66.00 | $66.00 – $66.00 |
| 6 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient | 6 | $0.02 | $0.01 – $0.02 |
| 7 | AMH Cath Labs LLC Arlington, TX case rate · outpatient | 1 | $133.96 | $133.96 – $133.96 |
| 8 | ATHOL MEMORIAL HOSPITAL INCORPORATED Athol, MA fee schedule · outpatient | 3 | $182.43 | $176.86 – $185.21 |
| 9 | AdventHealth Avista Louisville, CO fee schedule · outpatient | 1 | $143.42 | $143.42 – $143.42 |
| 10 | AdventHealth Deland Deland, FL fee schedule · outpatient | 1 | $143.20 | $143.20 – $143.20 |
| 11 | AdventHealth Littleton Littleton, CO fee schedule · outpatient | 1 | $141.85 | $141.85 – $141.85 |
| 12 | AdventHealth New Smyrna Beach New Smyrna Beach, FL fee schedule · outpatient | 1 | $143.20 | $143.20 – $143.20 |
| 13 | AdventHealth Orlando Winter Park, FL fee schedule · outpatient | 2 | $141.12 | $139.03 – $143.20 |
| 14 | AdventHealth Parker Aurora, CO fee schedule · outpatient | 1 | $141.85 | $141.85 – $141.85 |
| 15 | AdventHealth Porter Denver, CO fee schedule · outpatient | 1 | $141.85 | $141.85 – $141.85 |
| 16 | Adventhealth Carrollwood Tampa, FL fee schedule · outpatient | 1 | $141.81 | $141.81 – $141.81 |
| 17 | Adventhealth Central Texas Killeen, TX fee schedule · outpatient | 2 | $479.95 | $446.33 – $513.57 |
| 18 | Adventhealth Daytona Beach Port Orange, FL fee schedule · outpatient | 1 | $143.20 | $143.20 – $143.20 |
| 19 | Adventhealth Fish Memorial Deltona, FL fee schedule · outpatient | 1 | $143.20 | $143.20 – $143.20 |
| 20 | Adventhealth Gordon Calhoun, GA fee schedule · outpatient | 1 | $139.29 | $139.29 – $139.29 |
| 21 | Adventhealth Heart of Florida Winter Haven, FL fee schedule · outpatient | 1 | $143.20 | $143.20 – $143.20 |
| 22 | Adventhealth Lake Wales Lake Wales, FL fee schedule · outpatient | 1 | $143.20 | $143.20 – $143.20 |
| 23 | Adventhealth Murray Chatsworth, GA fee schedule · outpatient | 1 | $127.68 | $127.68 – $127.68 |
| 24 | Adventhealth North Pinellas Palm Harbor, FL fee schedule · outpatient | 1 | $141.81 | $141.81 – $141.81 |
| 25 | Adventhealth Ocala Ocala, FL fee schedule · outpatient | 1 | $143.20 | $143.20 – $143.20 |
← Payers reporting HCPCS G0463 · Snapshot 20261108T203506Z-bb90dbab