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 MultiPlan 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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702 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | AGH LAVEEN LLC Phoenix, AZ fee schedule · inpatient | 1 | $242.65 | $242.65 – $242.65 |
| 2 | AGH LAVEEN LLC Phoenix, AZ fee schedule · outpatient | 1 | $242.65 | $242.65 – $242.65 |
| 3 | AGH MESA LLC Mesa, AZ fee schedule · inpatient | 1 | $242.65 | $242.65 – $242.65 |
| 4 | AGH MESA LLC Mesa, AZ fee schedule · outpatient | 1 | $242.65 | $242.65 – $242.65 |
| 5 | AHS Hillcrest Medical Center, LLC Tulsa, OK facility · percent of total billed charges · bothfrom % of charges | 2 | $1,021 | $565.73 – $1,849 |
| 6 | AHS Southcrest Hospital, LLC Tulsa, OK facility · percent of total billed charges · bothfrom % of charges | 2 | $576.02 | $353.40 – $848.00 |
| 7 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $463.50 | $463.50 – $463.50 |
| 8 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · outpatientfrom % of charges | 1 | $102.00 | $102.00 – $102.00 |
| 9 | Affinity Hospital LLC Birmingham, AL facility · percent of total billed charges · inpatientfrom % of charges | 2 | $1,802 | $485.56 – $4,572 |
| 10 | Affinity Hospital LLC Birmingham, AL facility · percent of total billed charges · outpatientfrom % of charges | 2 | $2,090 | $493.52 – $10,351 |
| 11 | Aiken Regional Medical Centers North Augusta, SC percent of total billed charges · bothfrom % of charges | 1 | $1,608 | $102.85 – $5,566 |
| 12 | Alton Memorial Hospital Alton, IL percent of total billed charges · bothfrom % of charges | 1 | $365.25 | $189.00 – $543.75 |
| 13 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL percent of total billed charges · inpatientfrom % of charges | 1 | $237.50 | $237.50 – $237.50 |
| 14 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL percent of total billed charges · outpatientfrom % of charges | 1 | $237.50 | $237.50 – $237.50 |
| 15 | Armstrong County Memorial Hospital Kittanning, PA facility · percent of total billed charges · inpatientfrom % of charges | 1 | $376.20 | $376.20 – $376.20 |
| 16 | Armstrong County Memorial Hospital Kittanning, PA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $376.20 | $376.20 – $376.20 |
| 17 | Armstrong County Memorial Hospital Kittanning, PA professional · fee schedule · outpatient | 1 | $376.20 | $376.20 – $376.20 |
| 18 | Atrium Health Hospitals Inc Kings Mountain, NC percent of total billed charges · inpatientfrom % of charges | 1 | $463.92 | $175.99 – $1,016 |
| 19 | Atrium Health Hospitals Inc Kings Mountain, NC percent of total billed charges · outpatientfrom % of charges | 1 | $463.92 | $175.99 – $1,016 |
| 20 | Atrium Health Hospitals Inc Lincolnton, NC percent of total billed charges · inpatientfrom % of charges | 1 | $463.92 | $175.99 – $1,016 |
| 21 | Atrium Health Hospitals Inc Lincolnton, NC percent of total billed charges · outpatientfrom % of charges | 1 | $463.92 | $175.99 – $1,016 |
| 22 | Atrium Health Hospitals Inc Wadesboro, NC percent of total billed charges · inpatientfrom % of charges | 1 | $463.92 | $175.99 – $1,016 |
| 23 | Atrium Health Hospitals Inc Wadesboro, NC percent of total billed charges · outpatientfrom % of charges | 1 | $463.92 | $175.99 – $1,016 |
| 24 | BAPTIST HEALTHCARE SYSTEM INC Elizabethtown, KY percent of total billed charges · bothfrom % of charges | 1 | $315.51 | $315.51 – $315.51 |
| 25 | BAPTIST HEALTHCARE SYSTEM INC Elizabethtown, KY percent of total billed charges · outpatientfrom % of charges | 1 | $276.84 | $12.09 – $514.12 |
← Payers reporting HCPCS G0463 · Snapshot 20261108T203506Z-bb90dbab