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 Optum 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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191 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $54.56 | $54.56 – $54.56 |
| 2 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · fee schedule · outpatient | 1 | $119.07 | $119.07 – $119.07 |
| 3 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $291.49 | $291.49 – $291.49 |
| 4 | ARH Mary Breckinridge Health Services, Inc Barbourville, KY percent of total billed charges · outpatientfrom % of charges | 1 | $44.30 | $44.30 – $44.30 |
| 5 | ARH Mary Breckinridge Health Services, Inc Hayden, KY percent of total billed charges · outpatientfrom % of charges | 1 | $39.09 | $39.09 – $39.09 |
| 6 | ARH Mary Breckinridge Health Services, Inc Martin, KY percent of total billed charges · outpatientfrom % of charges | 1 | $51.60 | $51.60 – $51.60 |
| 7 | Acadia Hospital Bangor, ME facility · case rate · outpatient | 1 | $127.22 | $127.22 – $127.22 |
| 8 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $121.78 | $121.78 – $121.78 |
| 9 | Affinity Hospital LLC Birmingham, AL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $1,425 | $358.20 – $6,654 |
| 10 | Alta Newport Hospital, LLC Tustin, CA facility · case rate · outpatient | 2 | $130.16 | $128.87 – $131.45 |
| 11 | Appalachian Regional Healthcare, Inc. Liberty, KY percent of total billed charges · outpatientfrom % of charges | 1 | $54.72 | $54.72 – $54.72 |
| 12 | Appalachian Regional Healthcare, Inc. McDowell, KY percent of total billed charges · outpatientfrom % of charges | 1 | $43.86 | $43.86 – $43.86 |
| 13 | BRFHH MONROE, LLC Monroe, LA fee schedule · outpatient | 1 | $117.13 | $117.13 – $117.13 |
| 14 | Baylor Scott & White Medical Center - Plano Plano, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $201.92 | $131.46 – $227.50 |
| 15 | Baylor University Medical Center Dallas, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $201.92 | $131.46 – $227.50 |
| 16 | Betsy Johnson Hospital Dunn, NC facility · other · outpatient | 1 | $120.59 | $52.76 – $131.90 |
| 17 | Bluffton Health System LLC Bluffton, IN facility · per diem · outpatient | 1 | $140.86 | $140.86 – $140.86 |
| 18 | Brandon HMA LLC Brandon, MS facility · fee schedule · outpatient | 1 | $128.74 | $128.74 – $128.74 |
| 19 | CATHOLIC HEALTH INIATIVES COLORADO Westminster, CO fee schedule · outpatient | 1 | $133.30 | $133.30 – $133.30 |
| 20 | CATHOLIC HEALTH INITIATIVES COLORADO Pueblo, CO fee schedule · outpatient | 1 | $133.30 | $133.30 – $133.30 |
| 21 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $133.30 | $133.30 – $133.30 |
| 22 | CATHOLIC HEALTH INITIATIVES COLORADO Canon City, CO percent of total billed charges · outpatientfrom % of charges | 1 | $115.75 | $44.12 – $228.96 |
| 23 | CATHOLIC HEALTH INITIATIVES COLORADO Frisco, CO fee schedule · outpatient | 1 | $133.30 | $133.30 – $133.30 |
| 24 | CATHOLIC HEALTH INITIATIVES COLORADO Durango, CO fee schedule · outpatient | 1 | $133.30 | $133.30 – $133.30 |
| 25 | CATHOLIC HEALTH INITIATIVES COLORADO Lakewood, CO fee schedule · outpatient | 1 | $133.30 | $133.30 – $133.30 |
← Payers reporting HCPCS G0463 · Snapshot 20261108T203506Z-bb90dbab