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 Cigna 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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1,308 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | AHS Southcrest Hospital, LLC Tulsa, OK facility · percent of total billed charges · bothfrom % of charges | 1 | $326.78 | $236.40 – $417.64 |
| 2 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · fee schedule · outpatient | 1 | $129.74 | $129.74 – $129.74 |
| 3 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $412.00 | $412.00 – $412.00 |
| 4 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 2 | $242.83 | $132.65 – $353.01 |
| 5 | ATHOL MEMORIAL HOSPITAL INCORPORATED Athol, MA percent of total billed charges · outpatientfrom % of charges | 1 | $98.80 | $98.80 – $98.80 |
| 6 | AdventHealth Avista Louisville, CO fee schedule · outpatient | 1 | $144.84 | $144.84 – $144.84 |
| 7 | AdventHealth Littleton Littleton, CO fee schedule · outpatient | 1 | $143.25 | $143.25 – $143.25 |
| 8 | AdventHealth Parker Aurora, CO fee schedule · outpatient | 1 | $143.25 | $143.25 – $143.25 |
| 9 | AdventHealth Porter Denver, CO fee schedule · outpatient | 1 | $143.25 | $143.25 – $143.25 |
| 10 | Adventhealth Carrollwood Tampa, FL fee schedule · outpatient | 1 | $148.76 | $148.76 – $148.76 |
| 11 | Adventhealth Gordon Calhoun, GA fee schedule · outpatient | 1 | $132.52 | $132.52 – $132.52 |
| 12 | Adventhealth Lake Wales Lake Wales, FL fee schedule · outpatient | 1 | $148.76 | $148.76 – $148.76 |
| 13 | Adventhealth Murray Chatsworth, GA fee schedule · outpatient | 1 | $123.96 | $123.96 – $123.96 |
| 14 | Adventhealth North Pinellas Palm Harbor, FL fee schedule · outpatient | 1 | $148.76 | $148.76 – $148.76 |
| 15 | Adventhealth Tampa Brandon, FL fee schedule · outpatient | 1 | $148.76 | $148.76 – $148.76 |
| 16 | Adventhealth Wesley Chapel Lutz, FL fee schedule · outpatient | 1 | $148.76 | $148.76 – $148.76 |
| 17 | Adventhealth Zephyrhills Zephyrhills, FL fee schedule · outpatient | 1 | $148.76 | $148.76 – $148.76 |
| 18 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $207.62 | $207.23 – $212.95 |
| 19 | Alleghany County Memorial Hospital, Inc Sparta, NC facility · percent of total billed charges · inpatientfrom % of charges | 1 | $210.00 | $210.00 – $210.00 |
| 20 | Alleghany County Memorial Hospital, Inc Sparta, NC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $210.00 | $210.00 – $210.00 |
| 21 | Allen Memorial Hospital Corporation Waterloo, IA percent of total billed charges · inpatientfrom % of charges | 1 | $158.46 | $37.47 – $380.00 |
| 22 | Allen Memorial Hospital Corporation Waterloo, IA percent of total billed charges · outpatientfrom % of charges | 1 | $158.46 | $37.47 – $380.00 |
| 23 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 1 | $361.68 | $361.68 – $361.68 |
| 24 | Alton Memorial Hospital Alton, IL case rate · both | 3 | $5,517 | $3,756 – $6,771 |
| 25 | Alton Memorial Hospital Alton, IL case rate · outpatient | 3 | $5,517 | $3,756 – $6,771 |
← Payers reporting HCPCS G0463 · Snapshot 20261108T203506Z-bb90dbab