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 Highmark 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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205 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient | 4 | $39.86 | $36.63 – $43.09 |
| 2 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 19 | $175.81 | $80.19 – $274.33 |
| 3 | Alice Hyde Medical Center Malone, NY professional · percent of total billed charges · bothfrom % of charges | 1 | $190.12 | $190.12 – $190.12 |
| 4 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 4 | $123.60 | $111.87 – $136.02 |
| 5 | Armstrong County Memorial Hospital Kittanning, PA facility · other · outpatient | 4 | $275.01 | $156.74 – $330.09 |
| 6 | Armstrong County Memorial Hospital Kittanning, PA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $418.00 | $418.00 – $418.00 |
| 7 | Broaddus Hospital Association Inc Philippi, WV facility · percent of total billed charges · outpatientfrom % of charges | 2 | $133.19 | $129.11 – $137.27 |
| 8 | Bryn Mawr Rehabilitation Hospital Malvern, PA facility · fee schedule · outpatient | 1 | $143.94 | $143.94 – $143.94 |
| 9 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · case rate · outpatient | 3 | $208.19 | $121.49 – $290.57 |
| 10 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · percent of total billed charges · outpatientfrom % of charges | 3 | $72.35 | $25.24 – $140.81 |
| 11 | CANONSBURG GENERAL HOSPITAL CANONSBURG, PA fee schedule · outpatient | 19 | $171.18 | $79.77 – $260.03 |
| 12 | Camden-Clark Memorial Hospital Corporation Parkersburg, WV facility · other · outpatient | 3 | $101.59 | $51.08 – $138.68 |
| 13 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · fee schedule · both | 1 | $136.02 | $136.02 – $136.02 |
| 14 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · fee schedule · outpatient | 1 | $136.02 | $136.02 – $136.02 |
| 15 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA facility · fee schedule · both | 1 | $136.02 | $136.02 – $136.02 |
| 16 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA facility · fee schedule · outpatient | 1 | $136.02 | $136.02 – $136.02 |
| 17 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $149.53 | $149.53 – $149.53 |
| 18 | Charleston Area Medical Center Charleston, WV fee schedule · both | 1 | $112.17 | $112.17 – $112.17 |
| 19 | Charleston Area Medical Center Charleston, WV fee schedule · outpatient | 1 | $122.29 | $55.85 – $227.86 |
| 20 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 4 | $178.42 | $58.25 – $304.57 |
| 21 | Charleston Area Medical Center Charleston, WV percent of total billed charges · outpatientfrom % of charges | 3 | $229.00 | $203.74 – $463.25 |
| 22 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $149.53 | $149.53 – $149.53 |
| 23 | City Hospital, Inc. Martinsburg, WV facility · other · outpatient | 3 | $111.15 | $52.80 – $146.51 |
| 24 | Clarion Hospital Clarion, PA facility · case rate · outpatient | 2 | $182.56 | $122.73 – $278.37 |
| 25 | Clarion Hospital Clarion, PA facility · percent of total billed charges · outpatientfrom % of charges | 2 | $102.27 | $82.28 – $148.24 |
← Payers reporting HCPCS G0463 · Snapshot 20261108T203506Z-bb90dbab