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Ostomy Pouch, Urinary, for Use on Faceplate, Plastic

Pennsylvania rates for HCPCS A4381

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

Rates data updated July 2026.

Facilitymedian $5 · 10th–90th $3$370%20%10th90th$5Professionalmedian $4 · 10th–90th $3$60%20%10th90th$4$0.1$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$3.16
Median
$3.16
Typical High
$5.01
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.82
Median
$3.98
Typical High
$6.17
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
$6.46
Median
$6.46
Typical High
$6.46
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3.89
Median
$3.89
Typical High
$8.91
Cigna
Setting
Professional
Modifier
Global
Typical Low
$3.31
Median
$3.31
Typical High
$3.89
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$8.71
Typical High
$12.59
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$6.61
Typical High
$6.61
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$4.57
Typical High
$6.61
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$3.16
Median
$3.16
Typical High
$5.01
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$3.16
Median
$3.98
Typical High
$5.37
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$25.12
Typical High
$50.12
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$4.57
Median
$6.17
Typical High
$6.17
United
Setting
Facility
Modifier
Global
Typical Low
$2.19
Median
$2.95
Typical High
$4.07
United
Setting
Professional
Modifier
Global
Typical Low
$2.24
Median
$3.24
Typical High
$7.24