APC 5854

Partial hospitalization program (day treatment)

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-sonnet-5-5
Provider: anthropic
API: message_batches
Reasoning effort: model default
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Partial Hospitalization (

Payers reporting APC 5854

Payer pricing summary

Low

$88

Average

$197

Median

$173

High

$468

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +2 other terms	174	$168	$168	$7	4%	—	$146 – $212
2	Humana fee schedule · outpatient · +2 other terms	161	$165	$173	$50	29%	—	$144 – $684
3	Aetna fee schedule · outpatient · +2 other terms	155	$170	$171	$23	13%	—	$145 – $295
4	WellCare fee schedule · outpatient · +1 other terms	131	$170	$170	$8	5%	—	$147 – $207
5	Blue Cross Blue Shield fee schedule · outpatient · +2 other terms	125	$165	$168	$9	6%	—	$144 – $215
6	Devoted fee schedule · outpatient	122	$165	$165	$5	3%	—	$144 – $173
7	Cigna Healthspring fee schedule · outpatient	110	$173	$169	$7	4%	—	$165 – $183
8	Molina fee schedule · outpatient · +2 other terms	69	$242	$236	$90	38%	—	$155 – $432
9	Superior Healthplan fee schedule · outpatient	40	$173	$173	$0	0%	—	$173 – $173
10	Anthem fee schedule · outpatient · +1 other terms	31	$173	$171	$9	5%	—	$156 – $211
11	Oscar fee schedule · outpatient	27	$161	$183	$40	22%	—	$161 – $295
12	Amerihealth Caritas fee schedule · outpatient	17	$205	$201	$10	5%	—	$179 – $205
13	Cigna fee schedule · outpatient · +1 other terms	15	$167	$167	$5	3%	—	$158 – $175
14	Clover fee schedule · outpatient · +1 other terms	15	$173	$166	$8	5%	—	$151 – $173
15	Kaiser fee schedule · outpatient · +1 other terms	15	$176	$175	$2	1%	—	$172 – $176
16	Medicare case rate · outpatient	8	$153	$155	$4	2%	—	$153 – $164
17	Optum fee schedule · outpatient	8	$164	$246	$117	48%	—	$158 – $411
18	Ambetter case rate · outpatient · +2 other terms	7	$276	$277	$2	1%	—	$276 – $283
19	Tricare case rate · outpatient	7	$147	$147	—	—	—	$147 – $147
20	Excellus case rate · outpatient	5	$465	$468	$120	26%	—	$288 – $681
21	Highmark case rate · outpatient	5	$205	$291	$109	38%	—	$205 – $480
22	Sanford Health Plan case rate · outpatient	3	$244	$246	$25	10%	—	$204 – $281
23	Aetna Better Health facility · case rate · outpatient	1	$130	$130	$42	32%	—	$88 – $172
24	Magellan fee schedule · outpatient	1	$160	$160	—	—	—	$160 – $160
25	Medicaid facility · case rate · outpatient	1	$88	$88	—	—	—	$88 – $88