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 Humana 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.
Filter by billing methodology
Filter by billing class
1,194 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | AGH LAVEEN LLC Phoenix, AZ fee schedule · outpatient | 1 | $137.35 | $137.35 – $137.35 |
| 2 | AGH MESA LLC Mesa, AZ fee schedule · outpatient | 1 | $137.35 | $137.35 – $137.35 |
| 3 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · fee schedule · outpatient | 1 | $119.07 | $119.07 – $119.07 |
| 4 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 1 | $131.41 | $131.41 – $131.41 |
| 5 | AMH Cath Labs LLC Arlington, TX case rate · outpatient | 2 | $139.32 | $139.32 – $139.32 |
| 6 | ARH Mary Breckinridge Health Services, Inc Barbourville, KY percent of total billed charges · outpatientfrom % of charges | 2 | $44.08 | $43.86 – $44.30 |
| 7 | ARH Mary Breckinridge Health Services, Inc Hayden, KY percent of total billed charges · outpatientfrom % of charges | 2 | $38.90 | $38.70 – $39.09 |
| 8 | ARH Mary Breckinridge Health Services, Inc Martin, KY percent of total billed charges · outpatientfrom % of charges | 2 | $51.60 | $51.60 – $51.60 |
| 9 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 1 | $127.12 | $127.12 – $127.12 |
| 10 | AdventHealth Deland Deland, FL fee schedule · outpatient | 2 | $149.60 | $144.59 – $154.60 |
| 11 | AdventHealth Orlando Winter Park, FL fee schedule · outpatient | 1 | $145.98 | $145.98 – $145.98 |
| 12 | Adventhealth Daytona Beach Port Orange, FL fee schedule · outpatient | 2 | $148.28 | $144.59 – $151.96 |
| 13 | Adventhealth Fish Memorial Deltona, FL fee schedule · outpatient | 2 | $149.60 | $144.59 – $154.60 |
| 14 | Adventhealth Hendersonville Hendersonville, NC fee schedule · outpatient | 1 | $128.53 | $128.53 – $128.53 |
| 15 | Adventhealth North Pinellas Palm Harbor, FL fee schedule · outpatient | 1 | $139.03 | $139.03 – $139.03 |
| 16 | Adventhealth Palm Coast Palm Coast, FL fee schedule · outpatient | 2 | $149.60 | $144.59 – $154.60 |
| 17 | Adventhealth Redmond Rome, GA fee schedule · outpatient | 1 | $384.67 | $384.67 – $384.67 |
| 18 | Adventhealth Sebring Sebring, FL fee schedule · outpatient | 1 | $142.51 | $142.51 – $142.51 |
| 19 | Adventhealth Waterman Tavares, FL fee schedule · outpatient | 1 | $141.12 | $141.12 – $141.12 |
| 20 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $119.83 | $119.83 – $119.83 |
| 21 | Aiken Regional Medical Centers North Augusta, SC percent of total billed charges · bothfrom % of charges | 1 | $1,376 | $87.97 – $4,760 |
| 22 | Alice Hyde Medical Center Malone, NY professional · percent of total billed charges · bothfrom % of charges | 1 | $116.40 | $116.40 – $116.40 |
| 23 | Allen Memorial Hospital Corporation Waterloo, IA case rate · outpatient | 1 | $124.76 | $124.76 – $124.76 |
| 24 | Alta Newport Hospital, LLC Tustin, CA facility · case rate · outpatient | 1 | $128.87 | $128.87 – $128.87 |
| 25 | Alton Memorial Hospital Alton, IL case rate · both | 1 | $6,690 | $6,690 – $6,690 |
← Payers reporting HCPCS G0463 · Snapshot 20261108T203506Z-bb90dbab