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Ostomy Pouch, Urinary, for Use on Faceplate, Plastic

Illinois rates for HCPCS A4381

Ostomy pouch, urinary, for use on faceplate, plastic, each

Rates data updated July 2026.

Facilitymedian $7 · 10th–90th $4$350%20%10th90th$7Professionalmedian $4 · 10th–90th $3$90%20%10th90th$4$0.1$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
$3.63
Median
$3.63
Typical High
$6.61
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$3.98
Typical High
$6.61
BCBS
Setting
Facility
Modifier
Global
Typical Low
$9.33
Median
$16.22
Typical High
$56.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.89
Median
$3.89
Typical High
$7.24
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$3.31
Typical High
$7.24
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$13.18
Typical High
$17.38
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$8.32
Median
$8.32
Typical High
$8.32
Molina
Setting
Professional
Modifier
Global
Typical Low
$2.95
Median
$2.95
Typical High
$2.95
United
Setting
Facility
Modifier
Global
Typical Low
$2.04
Median
$6.61
Typical High
$6.61
United
Setting
Professional
Modifier
Global
Typical Low
$2.29
Median
$3.24
Typical High
$5.62