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Ostomy Pouch, Urinary, with Faceplate Attached, Plastic

Pennsylvania rates for HCPCS A4379

Ostomy pouch, urinary, with faceplate attached, plastic, each

Rates data updated July 2026.

Facilitymedian $16 · 10th–90th $10$1120%20%10th90th$16Professionalmedian $13 · 10th–90th $9$210%20%10th90th$13$0.2$2.0$20.0$200.0$2.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$10.23
Median
$10.23
Typical High
$16.22
Aetna
Setting
Professional
Modifier
Global
Typical Low
$9.12
Median
$12.88
Typical High
$19.95
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$20.89
Median
$20.89
Typical High
$20.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$13.80
Typical High
$28.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$11.75
Typical High
$11.75
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$19.50
Median
$28.18
Typical High
$40.74
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$21.38
Median
$21.38
Typical High
$21.38
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$15.14
Typical High
$21.38
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$10.23
Median
$10.23
Typical High
$16.22
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$10.23
Median
$12.88
Typical High
$17.38
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$19.95
Median
$75.86
Typical High
$123.03
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$19.95
Typical High
$19.95
United
Setting
Facility
Modifier
Global
Typical Low
$7.08
Median
$9.55
Typical High
$13.49
United
Setting
Professional
Modifier
Global
Typical Low
$7.41
Median
$10.47
Typical High
$23.44