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 Bcbs La 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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14 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | BRFHH MONROE, LLC Monroe, LA fee schedule · outpatient | 1 | $305.03 | $117.13 – $352.01 |
| 2 | Central Louisiana Surgical Hospital Alexandria, LA fee schedule · outpatient | 3 | $98.65 | $86.69 – $122.58 |
| 3 | Coushatta Health Care Center Coushatta, LA fee schedule · outpatient | 4 | $338.40 | $301.64 – $358.84 |
| 4 | EAST BATON ROUGE MEDICAL CENTER, LLC Baton Rouge, LA fee schedule · outpatient | 1 | $317.44 | $118.49 – $376.36 |
| 5 | Highland Medical Center - Shreveport Shreveport, LA fee schedule · outpatient | 5 | $258.22 | $121.81 – $330.38 |
| 6 | OCHSNER CLINIC FOUNDATION LA 70121; 4430 Veterans Memorial Blvd.Metairie, LA fee schedule · outpatient | 1 | $331.47 | $118.32 – $396.17 |
| 7 | OCHSNER LSU HEALTH SHREVEPORT - ST. MARY MEDICAL CENTER, LLC Shreveport, LA fee schedule · outpatient | 1 | $304.24 | $118.79 – $388.45 |
| 8 | Ochsner Lake Area Hospital Lake Charles, LA fee schedule · outpatient | 4 | $219.81 | $117.13 – $254.03 |
| 9 | Ochsner St. Patrick Hospital Lake Charles, LA fee schedule · outpatient | 4 | $223.27 | $119.08 – $258.00 |
| 10 | Opelousas General Main Campus Opelousas, LA facility · fee schedule · both | 4 | $76.18 | $30.36 – $210.00 |
| 11 | St Tammany Hosptial Service District No 2 Slidell, LA fee schedule · outpatient | 1 | $234.76 | $117.92 – $293.15 |
| 12 | St Tammany Hosptial Service District No 2 Slidell, LA fee schedule · outpatient | 1 | $234.76 | $117.92 – $293.15 |
| 13 | St. Frances Cabrini Hospital Alexandria, LA fee schedule · outpatient | 4 | $279.24 | $122.58 – $331.46 |
| 14 | UNIVERSITY HEALTH SHREVEPORT, LLC Shreveport, LA fee schedule · outpatient | 1 | $304.67 | $120.93 – $388.45 |
← Payers reporting HCPCS G0463 · Snapshot 20261108T203506Z-bb90dbab