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 Healthpartners 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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37 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 1 | $361.68 | $361.68 – $361.68 |
| 2 | Aspirus St. Luke’s Hospital Duluth, MN fee schedule · outpatient | 1 | $140.60 | $140.60 – $140.60 |
| 3 | Avera Behavioral Health Hospital Sioux Falls, SD percent of total billed charges · outpatientfrom % of charges | 1 | $67.77 | $67.77 – $67.77 |
| 4 | Avera Heart Hospital Sioux Falls, SD percent of total billed charges · outpatientfrom % of charges | 1 | $97.32 | $97.32 – $97.32 |
| 5 | Avera McKennan Hospital Sioux Falls, SD percent of total billed charges · outpatientfrom % of charges | 1 | $67.77 | $67.77 – $67.77 |
| 6 | Avera Specialty Hospital Sioux Falls, SD percent of total billed charges · outpatientfrom % of charges | 1 | $67.77 | $67.77 – $67.77 |
| 7 | Avera St. Luke's Aberdeen, SD percent of total billed charges · outpatientfrom % of charges | 1 | $88.13 | $88.13 – $88.13 |
| 8 | Avera St. Mary's Hospital Pierre, SD percent of total billed charges · outpatientfrom % of charges | 1 | $79.97 | $79.97 – $79.97 |
| 9 | BSA Hospital Amarillo, TX facility · percent of total billed charges · bothfrom % of charges | 1 | $485.11 | $296.21 – $757.22 |
| 10 | Benefis Hospitals Inc Helena, MT percent of total billed charges · bothfrom % of charges | 1 | $200.25 | $160.20 – $240.30 |
| 11 | Essentia Health Duluth Duluth, MN facility · case rate · outpatient | 1 | $126.47 | $126.47 – $126.47 |
| 12 | Essentia Health Fargo 3000 32nd Ave S Fargo, ND facility · case rate · outpatient | 1 | $128.87 | $128.87 – $128.87 |
| 13 | Essentia Health St. Joseph's Medical Center Brainerd, MN facility · case rate · outpatient | 1 | $138.42 | $138.42 – $138.42 |
| 14 | Essentia Health St. Mary's - Detroit Lakes 1027 Washington Ave. Detroit Lakes, MN facility · case rate · outpatient | 1 | $135.45 | $135.45 – $135.45 |
| 15 | Essentia Health St. Mary's Children's Hospital Duluth, MN facility · case rate · outpatient | 1 | $129.25 | $129.25 – $129.25 |
| 16 | Essentia Health St. Mary's Medical Center Duluth, MN facility · case rate · outpatient | 1 | $129.25 | $129.25 – $129.25 |
| 17 | Essentia Health Virginia 901 9th St N Virginia, MN facility · case rate · outpatient | 1 | $126.47 | $126.47 – $126.47 |
| 18 | Harrington Cancer Center Amarillo, TX facility · percent of total billed charges · bothfrom % of charges | 1 | $485.11 | $296.21 – $757.22 |
| 19 | Hutchinson Hospital Hutchinson, MN facility · percent of total billed charges · bothfrom % of charges | 1 | $104.30 | $104.30 – $104.30 |
| 20 | Lakeview Hospital Stillwater, MN facility · case rate · both | 1 | $240.42 | $240.42 – $240.42 |
| 21 | Mayo Clinic Rochester, MN facility · percent of total billed charges · bothfrom % of charges | 5 | $120.13 | $14.77 – $319.00 |
| 22 | Mayo Clinic Arizona Phoenix, AZ facility · percent of total billed charges · bothfrom % of charges | 3 | $191.20 | $165.60 – $228.00 |
| 23 | Methodist Hospital St. Louis Park, MN facility · case rate · both | 1 | $236.65 | $236.65 – $236.65 |
| 24 | Northfield Hospital Northfield, MN percent of total billed charges · bothfrom % of charges | 1 | $264.17 | $114.58 – $674.00 |
| 25 | Northfield Hospital Northfield, MN percent of total billed charges · outpatientfrom % of charges | 1 | $234.44 | $53.92 – $450.23 |
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