APC 05012

Clinic visits and related services

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

NEW COMPLEX VISIT W/PROCEDURE

Payers reporting APC 05012

Payer pricing summary

Low

$104

Average

$232

Median

$178

High

$631

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Medical Mutual facility · other · outpatient	2	$460	$449	$37	8%	1–10	$421 – $499
2	MultiPlan facility · other · outpatient · +1 other terms	2	$213	$213	$34	16%	1–10	$100 – $223
3	Humana fee schedule · outpatient · +2 other terms	86	$132	$135	$4	3%	—	$97 – $141
4	Caresource fee schedule · outpatient · +1 other terms	20	$137	$136	$1	1%	—	$135 – $137
5	UnitedHealthcare facility · fee schedule · outpatient · +4 other terms	17	$157	$225	$275	122%	—	$73 – $4.4k
6	Aetna facility · fee schedule · outpatient · +4 other terms	15	$130	$224	$130	58%	—	$118 – $412
7	Medicare facility · fee schedule · outpatient · +2 other terms	13	$137	$511	$1.1k	209%	—	$119 – $4.3k
8	Blue Cross Blue Shield fee schedule · outpatient · +4 other terms	11	$128	$133	$1	1%	—	$128 – $133
9	Molina facility · fee schedule · outpatient · +1 other terms	8	$173	$552	$1.1k	200%	—	$124 – $4.5k
10	Anthem facility · fee schedule · outpatient	5	$462	$372	$167	45%	—	$124 – $630
11	Clover fee schedule · outpatient	5	$140	$139	$1	1%	—	$138 – $140
12	Kaiser fee schedule · outpatient · +2 other terms	5	$137	$136	$1	1%	—	$135 – $137
13	WellCare fee schedule · outpatient · +2 other terms	5	$137	$136	$1	1%	—	$135 – $137
14	Aetna Better Health facility · other · outpatient · +1 other terms	4	$79	$79	—	—	—	$79 – $79
15	Ambetter facility · fee schedule · outpatient	4	$216	$424	$1.3k	312%	—	$169 – $8.1k
16	Cigna facility · fee schedule · outpatient · +1 other terms	4	$420	$660	$974	148%	—	$144 – $4.5k
17	Devoted facility · fee schedule · outpatient	4	$135	$311	$851	274%	—	$127 – $4.4k
18	Tricare facility · fee schedule · outpatient · +1 other terms	4	$150	$149	$8	5%	—	$136 – $157
19	Amerihealth Caritas facility · fee schedule · outpatient	3	$219	$270	$959	355%	—	$132 – $9.4k
20	Bcbs Mi facility · fee schedule · outpatient · +1 other terms	3	$131	$131	$2	2%	—	$128 – $135
21	Carefirst facility · fee schedule · outpatient	3	$157	$148	$9	6%	—	$139 – $157
22	Medica facility · fee schedule · outpatient	3	$143	$143	—	—	—	$143 – $143
23	Bcbs Ca facility · fee schedule · outpatient	2	$428	$239	$168	70%	—	$170 – $649
24	Cigna Healthspring facility · fee schedule · outpatient	1	$128	$128	—	—	—	$128 – $128
25	Highmark facility · fee schedule · outpatient · +1 other terms	1	$124	$124	$10	8%	—	$112 – $136

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