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Ostomy Pouch, Urinary, with Faceplate Attached, Plastic

Utah rates for HCPCS A4379

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

Rates data updated July 2026.

Facilitymedian $6 · 10th–90th $6$140%50%90th$6Professionalmedian $15 · 10th–90th $6$910%10%10th90th$15$0.2$1.0$5.0$20.0$100.0

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
$5.75
Median
$5.75
Typical High
$5.75
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$13.49
Typical High
$91.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$13.80
Typical High
$14.45
Cigna
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$11.75
Typical High
$13.80
Molina
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$15.49
Typical High
$20.89
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$15.14
Typical High
$23.44
Select Health
Setting
Facility
Modifier
Global
Typical Low
$21.38
Median
$21.38
Typical High
$21.38
Select Health
Setting
Professional
Modifier
Global
Typical Low
$10.72
Median
$21.38
Typical High
$21.38
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$21.38
Typical High
$25.70
United
Setting
Facility
Modifier
Global
Typical Low
$7.08
Median
$8.13
Typical High
$8.91
United
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$8.91
Typical High
$13.49