Unscheduled hospital outpatient clinic visit

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Est Eval Visit Level 5 - Psych|PROCEDURE PERFORMED ON INFANTS LESS THAN 4 KG

Payers reporting HCPCS G0463

64 payers file a negotiated rate for this code. Each is shown once, under the terms the most hospitals file it under; rates under different terms (billing class, payment method, setting) are never blended, so open a payer to see them all. Figures are hospital-level averages; the median is across hospitals.

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1	Aetna fee schedule · outpatient · +33 other terms	452	$141.98	$195.39	$7.01 – $16,128
2	UnitedHealthcare fee schedule · outpatient · +37 other terms	378	$135.86	$183.98	$12.77 – $13,440
3	Blue Cross Blue Shield fee schedule · outpatient · +29 other terms	325	$182.15	$252.41	$0.04 – $10,855
4	Humana fee schedule · outpatient · +30 other terms	302	$131.47	$134.00	$12.05 – $518.69
5	Cigna fee schedule · outpatient · +35 other terms	187	$146.95	$227.65	$0.07 – $18,278
6	WellCare fee schedule · outpatient · +22 other terms	171	$141.97	$143.10	$24.34 – $302.02
7	Molina fee schedule · outpatient · +25 other terms	152	$159.34	$173.11	$43.61 – $405.44
8	Ambetter facility · fee schedule · outpatient · +16 other terms	91	$226.72	$238.82	$12.38 – $354.53
9	Anthem fee schedule · outpatient · +29 other terms	91	$129.51	$220.80	$19.61 – $8,997
10	Devoted facility · fee schedule · outpatient · +13 other terms	79	$127.09	$132.89	$35.93 – $173.01
11	Tricare facility · fee schedule · outpatient · +18 other terms	74	$132.08	$132.47	$33.14 – $3,808
12	Kaiser fee schedule · outpatient · +24 other terms	67	$170.39	$145.96	$9.64 – $950.56
13	Oscar facility · fee schedule · outpatient · +14 other terms	51	$194.62	$190.55	$7.61 – $250.17
14	Highmark facility · fee schedule · outpatient · +18 other terms	49	$187.83	$211.63	$11.81 – $1,023
15	Clover fee schedule · outpatient · +7 other terms	41	$140.84	$140.82	$100.00 – $160.57
16	Caresource fee schedule · outpatient · +20 other terms	39	$143.15	$156.15	$7.01 – $240.28
17	Optum fee schedule · outpatient · +16 other terms	32	$133.30	$137.76	$117.13 – $260.80
18	Bcbs Tx fee schedule · outpatient · +5 other terms	31	$404.80	$383.42	$121.01 – $779.05
19	Medicare fee schedule · outpatient · +15 other terms	31	$133.30	$132.62	$117.32 – $133.30
20	MultiPlan fee schedule · outpatient · +17 other terms	31	$211.98	$200.46	$59.25 – $1,189
21	Aetna Better Health fee schedule · outpatient · +15 other terms	30	$95.70	$106.52	$19.64 – $204.03
22	Superior Healthplan facility · fee schedule · outpatient · +3 other terms	26	$140.43	$141.80	$9.77 – $532.85
23	Wellmark facility · fee schedule · outpatient · +15 other terms	25	$136.02	$129.01	$11.15 – $1,023
24	Baylor Scott White Health Plan facility · fee schedule · outpatient · +1 other terms	24	$183.00	$183.01	$160.49 – $221.03
25	Cigna Healthspring fee schedule · outpatient · +8 other terms	23	$128.70	$135.22	$117.87 – $141.97

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