Drainable ostomy pouch with attached faceplate

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

Drainable plastic pch w fcpl

Payers reporting HCPCS A4375

Payer pricing summary

Low

Average

$28

Median

$25

High

$69

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +8 other terms	299	$24	$37	$39	105%	—	$11 – $188
2	UnitedHealthcare fee schedule · outpatient · +12 other terms	288	$25	$24	$3	13%	—	$10 – $28
3	Aetna fee schedule · outpatient · +9 other terms	265	$25	$27	$13	48%	—	$11 – $148
4	WellCare fee schedule · outpatient · +5 other terms	184	$25	$26	$4	16%	—	$24 – $48
5	Blue Cross Blue Shield fee schedule · outpatient · +7 other terms	181	$25	$30	$15	50%	—	$0 – $109
6	Devoted fee schedule · outpatient · +2 other terms	163	$24	$25	$0	2%	—	$24 – $26
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$25	$25	$1	3%	—	$24 – $26
8	Molina fee schedule · outpatient · +4 other terms	96	$33	$34	$13	39%	—	$20 – $64
9	Cigna fee schedule · outpatient · +9 other terms	77	$25	$27	$7	24%	—	$24 – $61
10	Anthem fee schedule · outpatient · +6 other terms	73	$24	$25	$2	8%	—	$24 – $40
11	Superior Healthplan fee schedule · outpatient · +1 other terms	40	$26	$26	$0	0%	—	$24 – $26
12	Kaiser fee schedule · outpatient · +4 other terms	39	$24	$24	$1	2%	—	$24 – $25
13	Clover fee schedule · outpatient · +1 other terms	37	$24	$25	$1	3%	—	$24 – $26
14	Bcbs Tx fee schedule · outpatient	31	$23	$23	$7	29%	—	$17 – $84
15	Optum fee schedule · outpatient · +1 other terms	25	$24	$28	$12	42%	—	$24 – $61
16	Oscar fee schedule · outpatient · +4 other terms	24	$24	$25	$1	3%	—	$24 – $26
17	Caresource facility · case rate · outpatient · +5 other terms	20	$11	$19	$14	73%	—	$7 – $49
18	Medicare fee schedule · outpatient · +1 other terms	18	$24	$24	$0	1%	—	$24 – $24
19	Amerihealth Caritas fee schedule · outpatient · +2 other terms	16	$29	$29	$1	2%	—	$28 – $29
20	Wellmark fee schedule · both · +1 other terms	13	$22	$21	$1	3%	—	$18 – $22
21	Aetna Better Health fee schedule · outpatient · +2 other terms	12	$12	$17	$6	37%	—	$12 – $24
22	Ambetter case rate · outpatient · +5 other terms	12	$35	$36	$2	4%	—	$35 – $38
23	Bcbs Mn fee schedule · outpatient · +4 other terms	12	$21	$13	$11	84%	—	$0 – $26
24	Bcbs Nj fee schedule · outpatient	12	$24	$52	$35	68%	—	$24 – $106
25	Highmark fee schedule · outpatient · +5 other terms	10	$25	$26	$9	36%	—	$11 – $58

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