go back

Ostomy Pouch, Urinary, for Use on Faceplate, Rubber

Illinois rates for HCPCS A4383

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

Rates data updated July 2026.

Facilitymedian $40 · 10th–90th $22$2190%20%10th90th$40Professionalmedian $25 · 10th–90th $18$500%20%10th90th$25$0.5$2.0$10.0$50.0$200.0

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
$21.88
Median
$21.88
Typical High
$39.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$18.20
Median
$24.55
Typical High
$39.81
BCBS
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$104.71
Typical High
$346.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$26.30
Typical High
$44.67
Cigna
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$22.39
Typical High
$26.30
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$51.29
Typical High
$67.61
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
$51.29
Median
$51.29
Typical High
$51.29
Molina
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$18.62
Typical High
$18.62
United
Setting
Facility
Modifier
Global
Typical Low
$12.59
Median
$39.81
Typical High
$39.81
United
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$19.50
Typical High
$34.67