Drainable ostomy pouch with extended-wear barrier and filter

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 A5057) 1 PC OST POU W BUILT-IN CONV

Payers reporting HCPCS A5057

Payer pricing summary

Low

Average

$20

Median

$14

High

$114

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Humana fee schedule · outpatient · +9 other terms	301	$14	$21	$22	105%	—	$6 – $105
2	UnitedHealthcare fee schedule · outpatient · +12 other terms	290	$14	$13	$2	13%	—	$6 – $16
3	Aetna fee schedule · outpatient · +9 other terms	267	$14	$15	$7	48%	—	$6 – $83
4	WellCare fee schedule · outpatient · +5 other terms	185	$14	$15	$2	16%	—	$13 – $27
5	Blue Cross Blue Shield fee schedule · outpatient · +10 other terms	174	$14	$15	$5	29%	—	$0 – $44
6	Devoted fee schedule · outpatient · +3 other terms	163	$14	$14	$0	2%	—	$13 – $14
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$14	$14	$0	3%	—	$14 – $15
8	Molina fee schedule · outpatient · +6 other terms	97	$18	$19	$7	39%	—	$11 – $36
9	Cigna fee schedule · outpatient · +10 other terms	77	$14	$15	$4	24%	—	$13 – $34
10	Anthem fee schedule · outpatient · +7 other terms	74	$13	$14	$1	8%	—	$13 – $22
11	Superior Healthplan fee schedule · outpatient · +1 other terms	40	$14	$14	$0	0%	—	$13 – $14
12	Kaiser fee schedule · outpatient · +5 other terms	39	$13	$14	$0	2%	—	$13 – $14
13	Clover fee schedule · outpatient · +1 other terms	37	$14	$14	$0	3%	—	$13 – $14
14	Bcbs Tx fee schedule · outpatient	31	$13	$13	$4	29%	—	$9 – $47
15	Optum fee schedule · outpatient · +2 other terms	25	$14	$16	$7	42%	—	$13 – $34
16	Oscar fee schedule · outpatient · +3 other terms	24	$13	$14	$0	3%	—	$13 – $14
17	Caresource facility · case rate · outpatient · +5 other terms	20	$16	$18	$5	28%	—	$10 – $27
18	Medicare fee schedule · outpatient · +1 other terms	18	$13	$13	$0	1%	—	$13 – $13
19	Amerihealth Caritas fee schedule · outpatient · +2 other terms	16	$16	$16	$0	2%	—	$16 – $16
20	Aetna Better Health fee schedule · outpatient · +3 other terms	13	$6	$10	$3	36%	—	$6 – $14
21	Wellmark fee schedule · both · +1 other terms	13	$12	$12	$0	3%	—	$10 – $12
22	Ambetter case rate · outpatient · +5 other terms	12	$19	$20	$1	4%	—	$19 – $21
23	Bcbs Mn fee schedule · outpatient · +4 other terms	12	$12	$8	$6	81%	—	$0 – $15
24	Bcbs Nj fee schedule · outpatient	12	$13	$29	$20	68%	—	$13 – $59
25	Highmark fee schedule · outpatient · +4 other terms	10	$14	$15	$5	36%	—	$6 – $32

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