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 Healthcare Highways 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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22 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | AHS Hillcrest Medical Center, LLC Tulsa, OK facility · percent of total billed charges · bothfrom % of charges | 5 | $513.23 | $249.00 – $829.90 |
| 2 | AHS Southcrest Hospital, LLC Tulsa, OK facility · percent of total billed charges · bothfrom % of charges | 5 | $326.78 | $150.00 – $455.80 |
| 3 | Athens Hospital, LLC Athens, TX facility · percent of total billed charges · bothfrom % of charges | 3 | $129.75 | $106.00 – $156.00 |
| 4 | BSA Hospital Amarillo, TX facility · percent of total billed charges · bothfrom % of charges | 3 | $260.60 | $159.12 – $406.77 |
| 5 | Duncan Regional Hospital Duncan, OK percent of total billed charges · outpatientfrom % of charges | 2 | $136.11 | $62.48 – $330.20 |
| 6 | Durant HMA LLC Durant, OK facility · percent of total billed charges · inpatientfrom % of charges | 1 | $664.10 | $228.77 – $1,660 |
| 7 | Durant HMA LLC Durant, OK facility · percent of total billed charges · outpatientfrom % of charges | 1 | $664.10 | $228.77 – $1,660 |
| 8 | Hackensack Meridian Mountainside Medical Center Montclair, NJ facility · percent of total billed charges · bothfrom % of charges | 4 | $388.99 | $250.10 – $772.91 |
| 9 | Harrington Cancer Center Amarillo, TX facility · percent of total billed charges · bothfrom % of charges | 3 | $260.60 | $159.12 – $406.77 |
| 10 | Henderson Hospital, LLC Henderson, TX facility · percent of total billed charges · bothfrom % of charges | 3 | $120.15 | $98.25 – $144.00 |
| 11 | Jacksonville Hospital, LLC Jacksonville, TX facility · percent of total billed charges · bothfrom % of charges | 3 | $175.75 | $97.75 – $254.25 |
| 12 | Jefferson County Hospital OK Waurika, OK percent of total billed charges · outpatientfrom % of charges | 2 | $104.64 | $84.48 – $124.80 |
| 13 | Marshall County HMA, LLC Madill, OK facility · percent of total billed charges · inpatientfrom % of charges | 1 | $429.44 | $429.44 – $429.44 |
| 14 | Marshall County HMA, LLC Madill, OK facility · percent of total billed charges · outpatientfrom % of charges | 1 | $429.44 | $429.44 – $429.44 |
| 15 | Mercy Hospital Ada Inc Ada, OK facility · percent of total billed charges · outpatientfrom % of charges | 2 | $210.90 | $144.30 – $277.50 |
| 16 | Pittsburg Hospital, LLC Pittsburg, TX facility · percent of total billed charges · bothfrom % of charges | 3 | $65.03 | $39.51 – $118.63 |
| 17 | Quitman Hospital, LLC Quitman, TX facility · percent of total billed charges · bothfrom % of charges | 3 | $43.75 | $31.25 – $56.25 |
| 18 | Rehabilitation Hospital, LLC Tyler, TX facility · percent of total billed charges · bothfrom % of charges | 3 | $175.75 | $97.75 – $254.25 |
| 19 | Santa Rosa Hospital - San Marcos San Marcos, TX fee schedule · outpatient | 1 | $315.97 | $315.97 – $315.97 |
| 20 | The University of Kansas Health System- St. Francis Campus Topeka, KS facility · percent of total billed charges · bothfrom % of charges | 3 | $131.86 | $91.84 – $168.51 |
| 21 | Tyler Regional Hospital, LLC Tyler, TX facility · percent of total billed charges · bothfrom % of charges | 3 | $175.75 | $97.75 – $254.25 |
| 22 | UNIVERSITY OF TEXAS HEALTH CENTER AT TYLER Tyler, TX facility · percent of total billed charges · bothfrom % of charges | 3 | $119.70 | $97.75 – $143.75 |
← Payers reporting HCPCS G0463 · Snapshot 20261108T203506Z-bb90dbab