Urinary ostomy pouch with extended-wear barrier, convex (one-piece)

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

HC (SUP SHELL A4393) URINE PCH W EX WEAR BAR CONV

Payers reporting HCPCS A4393

Payer pricing summary

Low

Average

$23

Median

$14

High

$287

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +11 other terms	300	$13	$20	$21	105%	—	$6 – $99
2	UnitedHealthcare fee schedule · outpatient · +12 other terms	289	$13	$12	$2	13%	—	$5 – $15
3	Aetna fee schedule · outpatient · +10 other terms	266	$13	$14	$7	48%	—	$6 – $77
4	WellCare fee schedule · outpatient · +5 other terms	185	$13	$14	$2	16%	—	$13 – $25
5	Blue Cross Blue Shield fee schedule · outpatient · +10 other terms	181	$13	$16	$8	50%	—	$0 – $57
6	Devoted fee schedule · outpatient · +2 other terms	163	$13	$13	$0	2%	—	$12 – $14
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$13	$13	$0	3%	—	$13 – $14
8	Molina fee schedule · outpatient · +6 other terms	96	$17	$18	$7	39%	—	$11 – $34
9	Cigna fee schedule · outpatient · +10 other terms	77	$13	$14	$3	24%	—	$12 – $32
10	Anthem fee schedule · outpatient · +7 other terms	74	$13	$13	$1	8%	—	$12 – $21
11	Superior Healthplan fee schedule · outpatient · +1 other terms	40	$14	$14	$0	0%	—	$13 – $14
12	Kaiser fee schedule · outpatient · +4 other terms	39	$13	$13	$0	2%	—	$12 – $13
13	Clover fee schedule · outpatient · +1 other terms	37	$13	$13	$0	3%	—	$13 – $14
14	Bcbs Tx fee schedule · outpatient	31	$12	$12	$4	29%	—	$9 – $44
15	Optum fee schedule · outpatient · +2 other terms	25	$13	$15	$6	42%	—	$12 – $32
16	Oscar fee schedule · outpatient · +2 other terms	24	$13	$13	$0	3%	—	$13 – $14
17	Caresource facility · case rate · outpatient · +4 other terms	20	$16	$18	$5	26%	—	$10 – $27
18	Medicare fee schedule · outpatient	18	$12	$12	$0	1%	—	$12 – $13
19	Amerihealth Caritas fee schedule · outpatient · +2 other terms	16	$15	$15	$0	2%	—	$15 – $15
20	Wellmark fee schedule · both · +1 other terms	13	$11	$11	$0	3%	—	$9 – $11
21	Aetna Better Health fee schedule · outpatient · +2 other terms	12	$6	$9	$3	37%	—	$6 – $13
22	Ambetter case rate · outpatient · +5 other terms	12	$18	$19	$1	4%	—	$18 – $20
23	Bcbs Mn fee schedule · outpatient · +4 other terms	12	$11	$7	$6	80%	—	$0 – $14
24	Bcbs Nj fee schedule · outpatient	12	$10	$20	$17	88%	—	$7 – $56
25	Highmark fee schedule · outpatient · +4 other terms	12	$13	$14	$5	36%	—	$6 – $30

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