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Ostomy Pouch, Urinary, for Use on Faceplate, Rubber

California rates for HCPCS A4383

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

Rates data updated July 2026.

Facilitymedian $19 · 10th–90th $15$540%20%10th90th$19Professionalmedian $22 · 10th–90th $12$1700%10%20%10th90th$22$0.5$2.0$10.0$50.0$200.0$1.0K

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
$10.47
Median
$11.48
Typical High
$169.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$24.55
Typical High
$169.82
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$28.18
Typical High
$28.18
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$14.79
Median
$18.62
Typical High
$46.77
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$45.71
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$54.95
Typical High
$83.18
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$70.79
Typical High
$102.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$26.30
Typical High
$27.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$22.39
Typical High
$26.30
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$44.67
Typical High
$53.70
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$36.31
Typical High
$66.07
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$295.12
Typical High
$295.12
Molina
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$11.48
Median
$37.15
Typical High
$52.48
Providence
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$22.39
Typical High
$33.88
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$36.31
United
Setting
Facility
Modifier
Global
Typical Low
$2.75
Median
$15.14
Typical High
$17.78
United
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$17.78
Typical High
$41.69