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 Devoted 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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255 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Adventhealth Port Charlotte Port Charlotte, FL fee schedule · outpatient | 1 | $148.76 | $148.76 – $148.76 |
| 2 | Adventhealth Redmond Rome, GA fee schedule · outpatient | 1 | $145.29 | $145.29 – $145.29 |
| 3 | Adventhealth Sebring Sebring, FL fee schedule · outpatient | 1 | $148.76 | $148.76 – $148.76 |
| 4 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $122.23 | $122.23 – $122.23 |
| 5 | Alton Memorial Hospital Alton, IL other · both | 1 | $149.80 | $149.80 – $149.80 |
| 6 | Alton Memorial Hospital Alton, IL other · outpatient | 1 | $149.80 | $149.80 – $149.80 |
| 7 | Baptist Memorial Hospital-Collierville Collierville, TN facility · fee schedule · outpatient | 1 | $120.37 | $120.37 – $120.37 |
| 8 | Baptist Memorial Hospital-Crittenden West Memphis, AR facility · fee schedule · outpatient | 1 | $120.37 | $120.37 – $120.37 |
| 9 | Baptist Memorial Hospital-DeSoto Southaven, MS facility · fee schedule · outpatient | 1 | $120.37 | $120.37 – $120.37 |
| 10 | Baptist Memorial Hospital-Golden Triangle Columbus, MS facility · fee schedule · outpatient | 1 | $120.23 | $120.23 – $120.23 |
| 11 | Baptist Memorial Hospital-Memphis Memphis, TN facility · fee schedule · outpatient | 1 | $120.37 | $120.37 – $120.37 |
| 12 | Baptist Memorial Hospital-NEA Jonesboro, AR facility · fee schedule · outpatient | 1 | $121.12 | $121.12 – $121.12 |
| 13 | Baptist Memorial Hospital-North Mississippi Oxford, MS facility · fee schedule · outpatient | 1 | $119.58 | $119.58 – $119.58 |
| 14 | Baptist Memorial Hospital-Tipton Covington, TN facility · fee schedule · outpatient | 1 | $120.37 | $120.37 – $120.37 |
| 15 | Baptist Memorial Hospital-Women's Memphis, TN facility · fee schedule · outpatient | 1 | $120.37 | $120.37 – $120.37 |
| 16 | Barnes Jewish Hospital St. Louis, MO other · both | 1 | $112.02 | $56.01 – $140.02 |
| 17 | Barnes Jewish Hospital St. Louis, MO other · outpatient | 1 | $136.02 | $56.01 – $140.02 |
| 18 | Barnes Jewish St. Peters Hospital St. Peters, MO other · both | 1 | $140.02 | $140.02 – $140.02 |
| 19 | Barnes Jewish St. Peters Hospital St. Peters, MO other · outpatient | 1 | $140.02 | $140.02 – $140.02 |
| 20 | Bluffton Health System LLC Bluffton, IN facility · fee schedule · outpatient | 1 | $141.38 | $141.38 – $141.38 |
| 21 | Boulder Community Health Lafayette, CO facility · case rate · outpatient | 1 | $146.26 | $146.26 – $146.26 |
| 22 | Boulder Community Health Lafayette, CO facility · percent of total billed charges · inpatientfrom % of charges | 1 | $182.80 | $182.80 – $182.80 |
| 23 | Brandon HMA LLC Brandon, MS facility · fee schedule · outpatient | 1 | $129.21 | $129.21 – $129.21 |
| 24 | Bristol Regional Medical Center BRISTOL, VA fee schedule · both | 1 | $131.88 | $126.00 – $132.62 |
| 25 | Bryn Mawr Rehabilitation Hospital Malvern, PA facility · fee schedule · outpatient | 1 | $136.16 | $136.16 – $136.16 |
← Payers reporting HCPCS G0463 · Snapshot 20261108T203506Z-bb90dbab