Urinary ostomy pouch with attached rubber 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

Urinary rubber pouch w fcplt

Payers reporting HCPCS A4380

Payer pricing summary

Low

$14

Average

$61

Median

$54

High

$181

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +8 other terms	299	$53	$81	$85	105%	—	$24 – $409
2	UnitedHealthcare fee schedule · outpatient · +9 other terms	288	$53	$51	$7	13%	—	$22 – $61
3	Aetna fee schedule · outpatient · +7 other terms	265	$54	$58	$28	48%	—	$24 – $322
4	WellCare fee schedule · outpatient · +4 other terms	184	$55	$57	$9	16%	—	$52 – $104
5	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	181	$54	$65	$34	51%	—	$0 – $241
6	Devoted fee schedule · outpatient · +2 other terms	163	$53	$53	$1	2%	—	$51 – $56
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$55	$54	$1	3%	—	$53 – $57
8	Molina fee schedule · outpatient · +4 other terms	96	$72	$73	$28	39%	—	$44 – $139
9	Cigna fee schedule · outpatient · +5 other terms	77	$54	$59	$14	24%	—	$51 – $133
10	Anthem fee schedule · outpatient · +6 other terms	73	$52	$53	$4	8%	—	$51 – $87
11	Superior Healthplan fee schedule · outpatient	40	$56	$56	$0	0%	—	$52 – $56
12	Kaiser fee schedule · outpatient · +4 other terms	39	$52	$53	$1	2%	—	$51 – $54
13	Clover fee schedule · outpatient · +1 other terms	37	$53	$54	$2	3%	—	$52 – $56
14	Bcbs Tx fee schedule · outpatient	31	$49	$50	$15	29%	—	$37 – $182
15	Optum fee schedule · outpatient · +1 other terms	25	$53	$62	$26	42%	—	$51 – $133
16	Oscar fee schedule · outpatient · +2 other terms	24	$52	$54	$2	3%	—	$52 – $56
17	Caresource facility · case rate · outpatient · +4 other terms	20	$37	$50	$26	52%	—	$23 – $106
18	Medicare fee schedule · outpatient	18	$51	$51	$0	1%	—	$51 – $52
19	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$64	$63	$1	2%	—	$61 – $64
20	Wellmark fee schedule · both · +1 other terms	13	$47	$47	$1	3%	—	$38 – $47
21	Aetna Better Health fee schedule · outpatient · +2 other terms	12	$25	$36	$13	37%	—	$25 – $52
22	Ambetter case rate · outpatient · +5 other terms	12	$76	$78	$3	4%	—	$76 – $83
23	Bcbs Mn fee schedule · outpatient · +4 other terms	12	$45	$29	$25	86%	—	$0 – $57
24	Bcbs Nj fee schedule · outpatient	12	$52	$113	$76	68%	—	$52 – $231
25	Highmark fee schedule · outpatient · +4 other terms	10	$55	$56	$20	36%	—	$24 – $125

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