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 Caresource 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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224 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $57.43 | $57.43 – $57.43 |
| 2 | Adena Fayette Medical Center Washington Court House, OH facility · case rate · outpatient | 1 | $272.04 | $272.04 – $272.04 |
| 3 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 2 | $191.96 | $129.67 – $254.25 |
| 4 | BAPTIST HEALTHCARE SYSTEM INC Albany, IN other · both | 1 | $211.29 | $211.29 – $211.29 |
| 5 | BAPTIST HEALTHCARE SYSTEM INC Albany, IN other · outpatient | 1 | $211.29 | $211.29 – $211.29 |
| 6 | BAPTIST HEALTHCARE SYSTEM INC Corbin, KY other · both | 1 | $873.72 | $873.72 – $873.72 |
| 7 | BAPTIST HEALTHCARE SYSTEM INC Corbin, KY other · outpatient | 1 | $766.62 | $33.48 – $1,424 |
| 8 | BAPTIST HEALTHCARE SYSTEM INC Lexington, KY other · both | 1 | $970.80 | $970.80 – $970.80 |
| 9 | BAPTIST HEALTHCARE SYSTEM INC Lexington, KY other · outpatient | 1 | $851.81 | $37.20 – $1,582 |
| 10 | BAPTIST HEALTHCARE SYSTEM INC Richmond, KY other · both | 1 | $873.72 | $873.72 – $873.72 |
| 11 | BAPTIST HEALTHCARE SYSTEM INC Richmond, KY other · outpatient | 1 | $766.62 | $33.48 – $1,424 |
| 12 | BAPTIST HEALTHCARE SYSTEM INC Grange, KY other · both | 1 | $873.72 | $873.72 – $873.72 |
| 13 | BAPTIST HEALTHCARE SYSTEM INC Grange, KY other · outpatient | 1 | $766.62 | $33.48 – $1,424 |
| 14 | BAPTIST HEALTHCARE SYSTEM INC Paducah, KY other · both | 1 | $873.72 | $873.72 – $873.72 |
| 15 | BAPTIST HEALTHCARE SYSTEM INC Paducah, KY other · outpatient | 1 | $766.62 | $33.48 – $1,424 |
| 16 | BAPTIST HEALTHCARE SYSTEM INC. Louisville, KY other · both | 1 | $873.72 | $873.72 – $873.72 |
| 17 | BAPTIST HEALTHCARE SYSTEM INC. Louisville, KY other · outpatient | 1 | $766.62 | $33.48 – $1,424 |
| 18 | Barnesville Hospital Association, Inc. Barnesville, OH facility · other · outpatient | 1 | $129.00 | $129.00 – $129.00 |
| 19 | Bluffton Health System LLC Bluffton, IN facility · fee schedule · outpatient | 1 | $141.37 | $141.37 – $141.37 |
| 20 | Bluffton Health System LLC Bluffton, IN facility · other · outpatient | 2 | $167.15 | $159.12 – $295.62 |
| 21 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient | 1 | $59.62 | $59.62 – $59.62 |
| 22 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $107.59 | $107.59 – $107.59 |
| 23 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $66.08 | $66.08 – $66.08 |
| 24 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $67.52 | $67.52 – $67.52 |
| 25 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $70.35 | $70.35 – $70.35 |
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