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 WellCare 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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565 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 | AMH Cath Labs LLC Arlington, TX case rate · outpatient | 2 | $144.01 | $140.66 – $147.36 |
| 4 | ARH Mary Breckinridge Health Services, Inc Barbourville, KY percent of total billed charges · outpatientfrom % of charges | 2 | $44.30 | $44.30 – $44.30 |
| 5 | ARH Mary Breckinridge Health Services, Inc Hayden, KY percent of total billed charges · outpatientfrom % of charges | 2 | $39.09 | $39.09 – $39.09 |
| 6 | ARH Mary Breckinridge Health Services, Inc Martin, KY percent of total billed charges · outpatientfrom % of charges | 2 | $51.86 | $51.60 – $52.12 |
| 7 | Acadia Hospital Bangor, ME facility · case rate · outpatient | 1 | $127.22 | $127.22 – $127.22 |
| 8 | Adventhealth Carrollwood Tampa, FL fee schedule · outpatient | 1 | $155.72 | $155.72 – $155.72 |
| 9 | Adventhealth North Pinellas Palm Harbor, FL fee schedule · outpatient | 1 | $155.72 | $155.72 – $155.72 |
| 10 | Adventhealth Port Charlotte Port Charlotte, FL fee schedule · outpatient | 1 | $155.72 | $155.72 – $155.72 |
| 11 | Adventhealth Tampa Brandon, FL fee schedule · outpatient | 1 | $155.72 | $155.72 – $155.72 |
| 12 | Adventhealth Wesley Chapel Lutz, FL fee schedule · outpatient | 1 | $155.72 | $155.72 – $155.72 |
| 13 | Adventhealth Zephyrhills Zephyrhills, FL fee schedule · outpatient | 1 | $155.72 | $155.72 – $155.72 |
| 14 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 2 | $153.45 | $124.22 – $182.67 |
| 15 | Agnesian Healthcare Inc. Fond Du Lac, WI fee schedule · outpatient | 1 | $134.32 | $134.32 – $134.32 |
| 16 | Alleghany County Memorial Hospital, Inc Sparta, NC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $106.93 | $106.93 – $106.93 |
| 17 | Alta Newport Hospital, LLC Tustin, CA facility · case rate · outpatient | 1 | $131.45 | $131.45 – $131.45 |
| 18 | Appalachian Regional Healthcare, Inc. Liberty, KY percent of total billed charges · inpatientfrom % of charges | 1 | $54.72 | $54.72 – $54.72 |
| 19 | Appalachian Regional Healthcare, Inc. Liberty, KY percent of total billed charges · outpatientfrom % of charges | 1 | $54.72 | $54.72 – $54.72 |
| 20 | Appalachian Regional Healthcare, Inc. McDowell, KY percent of total billed charges · outpatientfrom % of charges | 2 | $44.08 | $43.86 – $44.30 |
| 21 | Arkansas Childrens Hospital Little Rock, AR facility · other · outpatient | 1 | $124.48 | $124.48 – $124.48 |
| 22 | Arkansas Childrens Northwest Springdale, AR facility · other · outpatient | 1 | $124.26 | $124.26 – $124.26 |
| 23 | Atrium Health Hospitals Inc Kings Mountain, NC percent of total billed charges · outpatientfrom % of charges | 1 | $70.22 | $26.64 – $153.77 |
| 24 | Atrium Health Hospitals Inc Lincolnton, NC percent of total billed charges · outpatientfrom % of charges | 1 | $56.11 | $21.29 – $122.87 |
| 25 | Atrium Health Hospitals Inc Wadesboro, NC percent of total billed charges · outpatientfrom % of charges | 1 | $74.42 | $28.23 – $162.97 |
← Payers reporting HCPCS G0463 · Snapshot 20261108T203506Z-bb90dbab