APC 5864

Partial hospitalization program for mental health

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 5864

Payer pricing summary

Low

$214

Average

$489

Median

$429

High

$1.2k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +2 other terms	174	$420	$419	$18	4%	—	$358 – $529
2	Humana fee schedule · outpatient · +2 other terms	161	$411	$433	$125	29%	—	$358 – $1.7k
3	Aetna fee schedule · outpatient · +2 other terms	155	$419	$427	$54	13%	—	$358 – $715
4	WellCare fee schedule · outpatient · +1 other terms	131	$424	$425	$20	5%	—	$367 – $519
5	Blue Cross Blue Shield fee schedule · outpatient · +2 other terms	125	$411	$419	$25	6%	—	$359 – $537
6	Devoted fee schedule · outpatient	122	$411	$412	$12	3%	—	$359 – $432
7	Cigna Healthspring fee schedule · outpatient	110	$432	$423	$18	4%	—	$411 – $458
8	Molina fee schedule · outpatient · +2 other terms	69	$606	$589	$227	39%	—	$389 – $1.1k
9	Superior Healthplan fee schedule · outpatient	43	$432	$432	$2	0%	—	$432 – $449
10	Anthem fee schedule · outpatient · +1 other terms	31	$432	$425	$24	6%	—	$389 – $527
11	Oscar fee schedule · outpatient	27	$403	$455	$94	21%	—	$403 – $715
12	Amerihealth Caritas fee schedule · outpatient	17	$513	$501	$26	5%	—	$446 – $513
13	Cigna fee schedule · outpatient · +1 other terms	15	$411	$412	$9	2%	—	$396 – $425
14	Clover fee schedule · outpatient · +1 other terms	15	$432	$414	$21	5%	—	$377 – $432
15	Kaiser fee schedule · outpatient · +1 other terms	15	$441	$437	$8	2%	—	$417 – $441
16	Medicare case rate · outpatient	8	$372	$376	$9	2%	—	$372 – $398
17	Optum fee schedule · outpatient	8	$411	$614	$293	48%	—	$384 – $1.0k
18	Ambetter case rate · outpatient · +2 other terms	7	$669	$672	$6	1%	—	$669 – $686
19	Tricare case rate · outpatient	7	$357	$357	—	—	—	$357 – $357
20	Excellus case rate · outpatient	5	$1.2k	$1.2k	$300	26%	—	$721 – $1.7k
21	Highmark case rate · outpatient	5	$511	$727	$273	38%	—	$511 – $1.2k
22	Sanford Health Plan case rate · outpatient	3	$592	$596	$60	10%	—	$495 – $682
23	Aetna Better Health facility · case rate · outpatient	1	$315	$315	$102	32%	—	$214 – $417
24	Magellan fee schedule · outpatient	1	$400	$400	—	—	—	$400 – $400
25	Medicaid facility · case rate · outpatient	1	$214	$214	—	—	—	$214 – $214