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 rubber pch w fcplt

Payers reporting HCPCS A4376

Payer pricing summary

Low

$18

Average

$77

Median

$68

High

$230

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +8 other terms	299	$68	$103	$109	105%	—	$31 – $522
2	UnitedHealthcare fee schedule · outpatient · +9 other terms	288	$68	$65	$9	13%	—	$28 – $78
3	Aetna fee schedule · outpatient · +7 other terms	265	$68	$74	$35	48%	—	$30 – $410
4	WellCare fee schedule · outpatient · +4 other terms	184	$70	$72	$12	16%	—	$66 – $132
5	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	181	$69	$83	$43	51%	—	$0 – $308
6	Devoted fee schedule · outpatient · +2 other terms	163	$68	$68	$1	2%	—	$65 – $72
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$70	$69	$2	3%	—	$68 – $73
8	Molina fee schedule · outpatient · +4 other terms	96	$92	$93	$36	39%	—	$57 – $178
9	Cigna fee schedule · outpatient · +5 other terms	77	$69	$75	$18	24%	—	$65 – $170
10	Anthem fee schedule · outpatient · +6 other terms	73	$66	$68	$5	8%	—	$65 – $110
11	Superior Healthplan fee schedule · outpatient	40	$71	$71	$0	0%	—	$66 – $71
12	Kaiser fee schedule · outpatient · +4 other terms	39	$66	$67	$2	2%	—	$65 – $69
13	Clover fee schedule · outpatient · +1 other terms	37	$68	$69	$2	3%	—	$66 – $71
14	Bcbs Tx fee schedule · outpatient	31	$62	$64	$19	29%	—	$47 – $232
15	Optum fee schedule · outpatient · +1 other terms	25	$68	$79	$33	42%	—	$65 – $170
16	Oscar fee schedule · outpatient · +2 other terms	24	$66	$68	$2	3%	—	$66 – $71
17	Caresource facility · case rate · outpatient · +4 other terms	20	$37	$57	$36	64%	—	$23 – $136
18	Medicare fee schedule · outpatient	18	$65	$65	$1	1%	—	$65 – $66
19	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$81	$81	$2	2%	—	$77 – $81
20	Wellmark fee schedule · both · +1 other terms	13	$60	$60	$2	3%	—	$49 – $60
21	Aetna Better Health fee schedule · outpatient · +2 other terms	12	$32	$46	$17	37%	—	$32 – $66
22	Ambetter case rate · outpatient · +5 other terms	12	$96	$99	$4	4%	—	$96 – $106
23	Bcbs Mn fee schedule · outpatient · +4 other terms	12	$58	$37	$32	86%	—	$0 – $72
24	Bcbs Nj fee schedule · outpatient	12	$66	$143	$97	68%	—	$66 – $294
25	Highmark fee schedule · outpatient · +4 other terms	10	$70	$72	$26	36%	—	$31 – $159

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