APC 5501

Eye muscle repair surgery, basic level

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

Level 1 Extraocular, Repair, and Plastic Eye Procedures

Payers reporting APC 5501

Payer pricing summary

Low

$299

Average

$972

Median

$659

High

$5.2k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Excellus case rate · outpatient · +1 other terms	5	$901	$906	$232	26%	85–94	$559 – $1.3k
2	Caresource facility · other · outpatient · +2 other terms	6	$203	$1.2k	$1.5k	127%	6–60	$80 – $3.9k
3	First Health other · outpatient · +1 other terms	5	$405	$374	$62	17%	5–50	$250 – $405
4	Bcbs Mi other · outpatient	1	$412	$412	—	—	1–10	$412 – $412
5	Bcbs Mn other · outpatient	1	$377	$377	—	—	1–10	$377 – $377
6	Healthcare Highways other · outpatient	1	$1.8k	$1.8k	—	—	1–10	$1.8k – $1.8k
7	Medicaid other · outpatient · +1 other terms	1	$1.9k	$1.9k	—	—	1–10	$1.9k – $1.9k
8	Medical Mutual other · outpatient · +2 other terms	1	$220	$220	—	—	1–10	$220 – $220
9	Ucare facility · other · outpatient	1	$462	$462	—	—	1–10	$462 – $462
10	UnitedHealthcare fee schedule · outpatient · +7 other terms	176	$325	$426	$325	76%	—	$278 – $1.5k
11	Humana fee schedule · outpatient · +6 other terms	162	$319	$334	$97	29%	—	$278 – $1.3k
12	Aetna fee schedule · outpatient · +5 other terms	156	$325	$328	$37	11%	—	$278 – $523
13	WellCare fee schedule · outpatient · +4 other terms	132	$328	$329	$16	5%	—	$284 – $402
14	Blue Cross Blue Shield fee schedule · outpatient · +7 other terms	127	$319	$335	$104	31%	—	$258 – $1.6k
15	Devoted fee schedule · outpatient · +3 other terms	122	$319	$319	$9	3%	—	$279 – $335
16	Cigna Healthspring fee schedule · outpatient · +1 other terms	110	$335	$328	$14	4%	—	$319 – $355
17	Molina fee schedule · outpatient · +5 other terms	69	$470	$454	$177	39%	—	$299 – $837
18	Superior Healthplan fee schedule · outpatient	40	$335	$335	$0	0%	—	$335 – $335
19	Anthem fee schedule · outpatient · +5 other terms	31	$335	$325	$22	7%	—	$299 – $408
20	Oscar fee schedule · outpatient · +3 other terms	27	$312	$349	$64	18%	—	$312 – $523
21	Medicare facility · fee schedule · outpatient · +2 other terms	22	$333	$2.0k	$2.5k	123%	—	$127 – $8.7k
22	Amerihealth Caritas fee schedule · outpatient	17	$431	$416	$32	8%	—	$346 – $431
23	Cigna fee schedule · outpatient · +5 other terms	17	$319	$351	$69	20%	—	$282 – $651
24	Clover fee schedule · outpatient · +3 other terms	15	$335	$321	$16	5%	—	$293 – $335
25	Kaiser fee schedule · outpatient · +3 other terms	15	$342	$337	$12	4%	—	$305 – $342

Page 1 of 2 · 37 payers